1406 Highway 71 North | Carroll, Iowa 51401

Nondiscrimination Notice

NOTICE OF NONDISCRIMINATION

Notice Informing Individuals about Nondiscrimination and Accessibility Requirements and Sample Nondiscrimination Statement: Discrimination is Against the Law

Carroll Dental Associates (Dr. Karl Eischeid, Dr. Nicholas Fangman, Dr. Marie G’Sell, Dr. Martin Halbur and Dr. Michelle Sturm) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.  Carroll Dental Associates does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Carroll Dental Associates (Dr. Karl Eischeid, Dr. Nicholas Fangman, Dr. Marie G’Sell, Dr. Martin Halbur
and Dr. Michelle Sturm):

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, staff verbal explanation, accessible electronic formats online)
  • Provides free language services to people whose primary language is not English, such as:
    • Delta Dental of Iowa Language Line Services
    • Information written in Spanish and a Spanish speaking staff member

If you need these services, contact Dr. Marie C. G’Sell, Civil Rights Coordinator.

If you believe that Carroll Dental Associates (Dr. Karl Eischeid, Dr. Nicholas Fangman, Dr. Marie G’Sell, Dr. Martin Halbur or Dr. Michelle Sturm) has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Dr. Marie C. G’Sell, Civil Rights Coordinator, 1406 North Highway 71, Carroll, IA 51401. Phone: 712-792-2528, Fax: 712-792-5547, email: dr-gsell@carrolldentalassociates.com.  You can file a grievance in person or by mail, fax, or email.  If you need help filing a grievance, Dr. Marie C. G’Sell,Civil Rights Coordinator, is available to help you.  You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-868-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html