Acknowledgment of Notice of Privacy Practices

Envision Eye and Wellness, LLC understands that discrimination is against the law and complies with all applicable Federal and State civil rights laws. Specifically, we do not discriminate on the basis of race, color, national origin, religion, age, disability, sex or sexual orientation, status as a parent or genetic information. We do not exclude patients or treat them any differently based on any of these factors.

Envision Eye and Wellness, LLC has policies specifically related to sensory and speech impairment, limited English proficiency, facility accessibility, and employment discrimination. Staff are trained regarding our policies related to nondiscrimination.

When necessary and free of charge to the patient, we:

  • Provide aids and services to patients with disabilities when necessary to effectively communicate with them

  • Provide qualified sign language interpreters for hearing-impaired patients

  • Provide language services to those patients who cannot effectively communicate in English. This may include qualified interpreters or written information.

Provision of such services will not be limited or denied unless the provision of such service would pose an undue hardship on the financial well-being of the practice or significantly interfere with normal practice operations.

Any individual who believes Envision Eye and Wellness, LLC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, religion, age, disability. sex or sexual orientation, status as parent, or based on genetic information, PLEASE LET US KNOW so we can work to further accommodate their needs. Patients have the right to file a grievance in person, by mail, fax or email.

Chelsey Kunkler, OD & Katrina Schlarman, OD
8035 Team Dr, Ste 5
Maria Stein, OH, 45860
419.210.5675

Individuals may also file a civil rights complaint with the US Department of Health and Human Services, Office for Civil Rights two ways:

1.Electronically through the Office of Civil Rights Complaint Portal: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
2. By mail or phone at:
US Department of Health and Human Services
200 Independence Avenue SW Room 509F, HHH Building
Washington, DC 20201
1-800-368-1019 1-800-537-7697 (TDD)