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I am an Authorized Agent making a request on behalf of a California consumer.
 
 
 
 
 

When you fill out this form your personal information will be collected, processed, and stored in accordance with our Privacy Policy. Please confirm you have read and agree to our privacy policy and that you consent to the collection, processing, and retention of your data by checking the box below. A member of the Health Advances team will confirm receipt of your request and provide information about how we will process your request.

 
 
I have read the Health Advances privacy policy and consent to the collection, processing and retention of my data.*