Personal Data Access, Rectification & Erasure Request

Please fill out this form if you are a resident of the European Union and wish to exercise your right to access, rectify, delete or object to further processing of the Personal Data we may have about you.

GDPR data rights Response within 30 days Free of charge
Your privacy

About Your Personal Information

The information you provide here will be processed solely for the purpose of verifying your identity, identifying the information you're requesting, and answering your request.

Your personal information will be accessed by our client's staff only.

What happens next

How we will process your request

We will answer your request, or request additional information from you within 30 days.

The processing of this request is free of charge, but we reserve the right, as allowed under GDPR Article 12 (5), to charge an administrative fee under certain circumstances.

Please note that we may refuse to act, as allowed under GDPR Article 12 (2) and 12 (5), on requests that are insufficiently substantiated, unfounded or excessive.

Prefer another way to reach us? If you would rather not complete this form, you may submit your request through our secure contact form or call us at (888) 595-2672.

Submit your request

Complete the fields below so we can verify your identity and answer your request. The more details you provide, the better we will be able to help.

Please don't include patient account numbers, SSNs, dates of birth, or any health information. For account/payment help use our secure Payment Portal; for compliance concerns, use our compliance form.

Please specify the information and the processing activity to which your request relate. The more details you provide, the better we will be able to answer your request.

Thank you — your request has been received. We will answer your request, or request additional information from you, within 30 days.

By submitting, you confirm the information above will be processed solely to verify your identity, identify the information you're requesting, and answer your request. See our Privacy Policy for details.