Personal Data Deletion Request

To whom it may concern:

This notice is to inform you that I would like to have my personal data deleted from your records. My full name and contact information are listed below:

The reason I am requesting deletion of my personal data is as follows:

  • Consent is being revoked for personal data processing

The information that I am specifically aware of, that you process or retain, is as follows:

  • Full Name
  • Address
  • Phone Number
  • Email Address
  • Treatment History
  • Before & After Photos of Patients (if applicable)

Please respond via email to confirm that my request has been honored.

Sincerely,