California Consumer Privacy Act Request Form
California residents have the right to make certain requests regarding the use of their personal data under the California Consumer Privacy Act (CCPA). For more information about these rights, please see our Privacy Policy:  

If you are a resident of California and you wish to submit a CCPA request to Backpack Health, please select “Next” below and complete the form. We may request additional information or documentation to verify identities and/or locate personal information, if any, in our records and systems.  

This form is for making a request regarding the personal data associated with an individual Backpack Health profile, which can represent a user or a dependent. A separate form must be submitted for each profile.

“Consumer” refers to the individual for whom you are making the request. If your request relates to your own information, then you are both the “requestor” and the “consumer”. If you’re making the request on behalf of a dependent, that individual is the “consumer”. When you enter the "requestor” and/ or “consumer” email address, please make sure to use the email address associated with your/their Backpack Health account.  

Alternatively, you can make your request by emailing us at Please include the requestor and consumer details referenced in the form, and note “California Privacy Rights” in the email subject line.
Sign in to Google to save your progress. Learn more
Clear form
Never submit passwords through Google Forms.
This form was created inside of Backpack Health. Report Abuse