California Consumer Privacy Rights Request Form


The California Consumer Privacy Act, as amended by the California Privacy Rights Act (CCPA), provides specific privacy rights to California residents. If you are currently a California resident, you may use this form to submit a request regarding your personal information that is processed by Strive Health.


The information you provide below will facilitate your request. If you do not provide the information requested below we may not be able to accurately identify you and process your request. Any information you provide below will not be used, shared, or retained for any purpose other than confirming your identity and processing the request. We will respond as soon as possible once the form is submitted.


For more information about how we may use and share personal information, please refer to our Privacy Policy.


Authorized Agents

If you are completing the form as an authorized agent, we may contact you to obtain proof that the consumer who's information is subject to the request gave you permission to make the request; or we may request proof of your legal authority to act on the consumer's behalf.


Please Note

These privacy rights do not apply to non-California residents, and do not apply to information classified as Protected Health Information (PHI) under the Health Insurance Portability & Accountability Act (HIPAA). For information on how we may use and share PHI, please refer to our Notice of Privacy Practices.

Individual Consumer
Consumer of a Household
Business-to-Business Consumer
Current or Former Strive Health Employee/Job Applicant/Contractor
Minor Consumer or Parent/Guardian of Minor Consumer
Authorized Agent of a Consumer
Delete Personal Information
Access Copies of Personal Information
Access Categories and Sources of Personal Information
Access Copies, Categories, and Sources of Personal Information
Correct Inaccurate Personal Information
Do Not Sell or Share Personal Information
Limit Use and Disclosure of Sensitive Personal Information
Enter the first name of the data subject
Enter the last name of the data subject
Enter email for correspondence with the data request.
Acknowledgment

By submitting this form, I attest that:

  • the consumer who is subject to the personal information above is currently a resident of California;
  • the information I have provided is accurate and true; and
  • I understand that my identity must be verified before Strive Health will process my request.


If you have any documentation in support of your request or evidence of your authority as an authorized agent, please attach it using the button below. Up to 10 files may be selected.