Non Discrimination Notice at Urgent Care & Walk-in Clinic in Dalton, GA

AFC Urgent Care/Family Care complies with applicable Federal civil rights laws and does not discriminate, exclude, or treat differently on the basis of race, color, national origin, age, disability or sex.

AFC Urgent Care/Family Care:

• 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
• Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreter services
  • Information written in other languages

If you need these services, please notify clinic staff.

If you believe that AFC Urgent Care/Family Care 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:

Jack Fromm, Compliance Officer

1025 Peerless Crossing NW

Cleveland, TN 37312

423.476.5990 (p)

423.476.5887 (f)

jfromm@afcurgentcare.com

You can file a grievance in person or by mail, fax, or email. If you need help filing grievances contact: David Farlett, Chief Financial Officer.

David Farlett, Chief Financial Officer

1025 Peerless Crossing NW

Cleveland, TN 37312

423.476.5990 (p)

423.476.5887 (f)

dfarlett@afcurgentcare.com

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/smartscreen/main.jsf or by mail or phone at

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at https://www.hhs.gov/.