Commitment to safety and outstanding patient care.
Always ready to respond when it matters most.
Our patient advocates are standing by.
The CCPA allows you to designate an Authorized Agent to act on your behalf, including to submit requests. Please fill out the below form:
Consumer Information
Authorized Agent Information
Deliver Information Requested by Agent:
to me, the Consumerto my Authorized Agent
Allow My Authorized Agent to Make(select all that apply):
Access RequestsDeletion RequestsPortability Requests
Consumer Authorization
By submitting this form, you give your full authorization for the above-mentioned individual to be your Authorized Agent, as permitted under the CCPA.