Privacy Rights Request

Under state privacy laws (including CCPA/CPRA, VCDPA, CPA, and others), you have the right to access, delete, correct, or port your personal information, and to limit certain uses of sensitive data. Use this form to submit a request. We will acknowledge your request within 10 business days and respond within 45 days.

Patient medical records: if you are a patient seeking access to your medical records, please contact your healthcare provider directly. Those requests are governed by HIPAA and handled separately from this form.

First name *

Last name *

Email address *

Phone (optional)

State of residence *

Your relationship to Cascala *

What right would you like to exercise? *

Right to know what personal information you have about me Right to delete my personal information Right to correct inaccurate personal information Right to a copy of my personal information (portability) Right to limit use of sensitive personal information Right to opt out of automated decision-making

Select all that apply.

Additional details about your request

I am submitting this request: *

On my own behalf As an authorized agent for another person

Agent's full name

Agent's email

Proof of authorization

I declare under penalty of perjury that I am the person identified above (or their authorized agent) and that the information I have provided is accurate.

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.