Request for Implementation of Privacy Rights
Request for Implementation of Privacy Rights
Date
Date
/
MM
/
DD
YYYY
Name
Name
*
First
Last
Email
*
Phone
*
This request is related to (select all that apply):
*
This request is related to (select all that apply):
Right of access
Right to rectification
Right to erasure (‘right to be forgotten’)
Right to restriction of processing
Right to object
Right to data portability
Description of the request
Please describe your request. In order to help you even more, we would like to know the reasons for it.
*
Preferred way for feedback on the request:
*
Preferred way for feedback on the request:
In writing to the email address above
In person
Other
Other
How should we contact you to schedule an appointment?
*
How should we contact you to schedule an appointment?
email
phone