Privacy Rights Request Form

We respect your privacy and provide this form to help you exercise your legal data rights under applicable state privacy laws.

State data privacy laws provide consumers with specific rights regarding their personal information. In accordance with legal guidelines, Wellness Wag never asks for a government ID photo, Social Security Number, or sensitive credentials to process your request.

1. Select Request Type(s)*

Know / Access My Personal Information — Request a copy of the specific pieces and categories of personal information we have collected about you.

Delete My Personal Information — Request that we delete personal information collected from you, subject to legal exceptions.

Correct Inaccurate Information — Request correction of inaccurate personal information that we maintain about you. (Requires explanation in the details field below)

Opt Out of Sale / Sharing (Targeted Advertising) — Direct us not to sell or share your personal information for cross-context behavioral advertising. (Processed immediately without verification)

Limit Use of Sensitive Personal Information — Direct us to limit the use and disclosure of your sensitive personal information to strictly necessary service purposes.

Appeal a Prior Decision — Submit an appeal regarding a previous privacy request determination. (Requires original request ID and details below)

Select all options that apply to your request:

Important Notice regarding Deletion: Requesting deletion permanently removes your personal information and transaction records across our systems, subject to legal and regulatory retention obligations. To safeguard your data against unauthorized deletion, you will receive an identity verification email that must be confirmed within 72 hours.

Immediate Opt-Out Processing: Direct requests to opt out of the sale or sharing of personal data do not require identity verification and will be applied directly across our systems upon submission.

2. Submitting As*

Myself — I am making this request for myself

Authorized Agent — I am authorized to act on behalf of the consumer

3. Consumer Information

First Name*

Last Name*

Email Address*

Please use the email address associated with your Wellness Wag account or prior interactions.

State of Residence*

Phone Number (Optional)

US numbers only. Enter a 10-digit phone number.

Order or Account Reference (Optional)

Helps our records operations team locate your profile more quickly without requesting further details.

Specific information required: Please describe which records are inaccurate and specify the updated information, or provide the reference ID of the determination you are appealing.

Request Details (Optional)

Request Details * (Required for Correct & Appeal)*

Authorized Agent Information

Under state regulations, authorized agents must provide valid documentation demonstrating legal authority to act on behalf of the consumer (e.g. written authorization signed by the consumer or a valid Power of Attorney).

Agent Full Name*

Organization / Agency (Optional)

Agent Email Address*

Agent Phone Number (Optional)

US numbers only. Enter a 10-digit phone number.

Signed Authorization Document

Choose file or drag & drop. PDF, JPG, or PNG document. Max size: 10 MB.

Legal Attestation: I am the consumer named above, or an authorized agent legally permitted to act on their behalf, and I certify under penalty of perjury that the information provided in this request is true and accurate.

Alternative Submission Methods

You may also exercise your data privacy rights by emailing our Privacy Team at [email protected] or by calling us at (415) 570-7864.

Submissions are encrypted in transit and handled strictly per CCPA/CPPA guidelines.

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Privacy Rights Request Form

3. Consumer Information

Authorized Agent Information

Alternative Submission Methods

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