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:

EmailPhoneFirst NameLast NameAddressAddress 2CityStateZipcode

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,Signature