California Consumer Privacy Act Request Form

Request Personal Data

Effective January 1, 2020, The California Consumer Privacy Act (CCPA) gives California residents the right to 1) access certain personal information a business has collected about them during the prior 12 months and to 2) request deletion of their personal information.


Personal Info
Please describe in what capacity or context you have interacted with us to date in which you may have provided personal information to us: Check All Boxes that Apply                         
Request Type
Please select only one option below. If you have multiple requests, kindly fill out another form and submit it separately.
Please send me a copy of the information In-Shape Health Solutions, LLC has collected about me in the last twelve months.
• The categories of personal information you have collected about me within the last 12 months
• The categories of sources from which the personal information was collected
• The business or commercial purpose for collecting, selling, or sharing this information
• The categories of third parties with whom you share or have shared my personal information
I do not want my personal information to be sold. Please cease and refrain from selling my personal information.
Please limit the use or disclosure of your sensitive personal information
Please delete all personal information that In-Shape Health Solutions, LLC has collected about me.
Authorized Agent Verification