Privacy Concern / Data Deletion Request

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This form is intended only for CarePilot customers and their authorized healthcare-provider staff to raise privacy concerns or request deletion of data associated with their CarePilot accounts.

Patients: please do not use this form. Instead, contact your healthcare provider directly or reach out to CarePilot Support at support@carepilot.com so we can route your request appropriately.

After you submit the form, a member of our Privacy Team will contact you to gather any additional details and guide you through next steps.

NOTE: Do not include any Protected Health Information (PHI) in your submission.

First and Last Name *

Organization Name

Email Address associated with your CarePilot Account *

Phone Number *

Request Type (Do Not Include PHI In Your Response) *

Account Deletion Request

Privacy Concern

Other:

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