California Consumer Privacy Act (CCPA) Request Form

This form is for the submission of any consumer requests under the California Consumer Privacy Act to Ai medica and its subsidiaries and affiliates (collectively, "Ai medica"). Please complete the form below and we will respond to your inquiry promptly.

Please note, If you are a California resident, you have certain rights under the California Consumer Privacy Act, including the right to access information about or request deletion of your personal information. You also have the right to opt-out of the sale of your personal information to third parties.

Ai medica does not generally sell information as the term "sell" is traditionally understood. To the extent "sale" under the CCPA is interpreted to include advertising technology activities such as those disclosed in the Web Beacon and Cookie sections of the Privacy Policy as a "sale", you may opt-out of the advertising technologies by toggling the switch on the Advertising Cookies tab of our cookie notification pop-up banner. Please remember that cookie-level opt-outs are browser and device-specific. If you use multiple devices such as your smartphone, laptop or tablet, you will need to submit separate requests from these devices.

Category of CCPA

Personal Information


Personal information categories listed in the California Customer Records statute (Cal. Civ. Code § 1798.80(e)).

Biometric information.

Internet or other similar network activity.

Sensory data.

Professional or employment-related information.

Inferences drawn from other Personal Information.

I am a(an):
Select request type(s):
I am a resident of the State of California. (Check One)

Request Details:*

(If you think you have a medical emergency, please call your doctor or dial 911 immediately. This CCPA form is only monitored for CCPA related requests and is not intended for any electronic communications regarding any medical needs or non-CCPA related inquiries.)

Thanks for submitting!