Contact Us/Forms – Acadian Oral Surgery, LLC

Please Contact Us

If you would like to schedule an appointment, please call us.

To expedite matters, on your computer, please complete the forms linked below, print them, sign them and bring them with you to your appointment. if you wish, the completed forms may be saved to your hard drive. Do not be tempted to attach the completed forms to an e-mail. Sensitive information should not be on the Internet.

(If you experience difficulty completing the digital forms, please highlight the fields using the highlight tool above the “print form” button at the upper right corner of the documents.)

Explanation of Office Policy (Please read carefully)

Discrimination is against the law.
Acadian Oral Surgery Complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Acadian Oral Surgery Does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Acadian Oral Surgery 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, audio, accessible electronic formats) Provides free language services to people whose primary language is not English, such as: Spanish, French, Vietnamese, Chinese, Arabic, Tagalog, Korean, Portuguese, Laotian, Japanese, Urdu, German, Persian, Russian, Thai. Qualified interpreters, Information written in other languages.
If you need these services, contact Debbie or Becky.
If you believe that Acadian Oral Surgery, 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 the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at:
HHS.gov,
or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue,
SW Room 509FHHH Building
Washington, D.C. 20201
1-800-368-1019,
800-537-7697 (TDD)
Complaint forms are available at http:www.jjs.gov/ocr/office/file/index.html.