Data Subject Access Request Form

Service provider

Companion Medical Scribe Ai / companionscribeai.com

What is your full name?

What is the email address you use to access the above app and website?

I am submitting this information on behalf of:

Myself

Someone else

What is the reason of your request?

Get a copy of my personal information

Edit or correct my personal information

Restrict the processing of my personal information

Delete all my personal information

Allow the disclosure and sale of my personal information to third parties

Deny the right to have my personal information disclosed or sold to third parties

I confirm the following:

Under penalty of perjury, I declare all the above information to be true and accurate.

I am the consumer of the above app and website or the agent authorized by the consumer to make this request on their behalf.

I understand that the deletion or restriction of my personal information is irreversible and may result in the termination of services with the above app and website.

I have read and agree to the privacy policy and I understand that I will be required to validate my request by email and I may be contacted in order to complete the request.

You’re not a bot, are you?

Data subject access request form