Under California Civil Code Section 1798.120, California users may submit a request to Powers Family Medicine to exercise certain privacy rights. If you are a California resident, please complete this form to submit a Data Deletion Request or a Data Access Request and we will respond within five (5) business days.

For more information about our Privacy Practices, please visit us here at www.PowersFamilyMedicine.com/privacy-policy.

I am submitting this request on behalf of:

Myself

My Household

A California Resident

Name

First Name

Last Name

Zip Code

State

Request Type

Data Deletion Request

Data Access Request

Request Details

Acknowledgement

I am I am a resident of California. I confirm that the information I have provided is accurate.

I am legally authorized to submit this request on behalf of a California resident. I confirm that the information I have provided is accurate.