Information Request

This form applies solely to California, Colorado, Connecticut, Delaware, Iowa, Maryland and New Jersey residents whose personal information is processed by Centauri Health Solutions, Inc. (collectively, “Centauri”, “we”, “us” or “our”)

If you are a California, Colorado, Connecticut, Delaware, Iowa, Maryland or New Jersey resident, you may request to exercise your rights under the comprehensive privacy laws of those States by completing the request form below or calling us at 888-447-8908. For more information about your rights and our privacy practices, please see our Privacy Policy. If you are an employee or job applicant, please see our California Employee, Job Applicant and Independent Contractor Privacy Notice.

 

Type of Request(Required)
Who is Making this Request(Required)
Your Name(Required)

 

Acknowledgement

Upon our receipt of this request, we may verify your identity by matching the information you provide with the information we have in our records. We may request additional information to verify your identity or to otherwise comply with your request.

By submitting this form, you confirm that you are (or, if you are an authorized agent, the data subject is) a resident of California, Colorado, Connecticut, Delaware, Iowa, Maryland or New Jersey and that the information you have provided is accurate and agree to our Privacy Policy. If you are an employee, job applicant or independent contractor, you agree to our California Employee, Job Applicant and Independent Contractor Privacy Notice.