Data Subject Request Form

This form is not intended for use by clients of providers using TherapyNotes.  To exercise your data rights, please contact the practice directly.

This form is not to be used for scheduling of appointments. If you need assistance, please contact the following:
 Emergency Resources

FOR CALIFORNIA RESIDENTS:  Use this form to exercise your privacy rights.  Data collected in this form will be used solely for verifying and acting on your request. If you are acting on behalf of someone else, please enter their information in the form.  Include your contact information in the description so that we may verify the request.

If you are not a California resident, we are not required to respond to your request at this time.