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California Privacy Rights Act Request Form

Under the California Privacy Rights Act (“CPRA”), residents of the State of California have, subject to exceptions, the right to know about the personal information that Pacific Home Care Services (the “Company”) collects about them, to correct inaccurate personal information about them, to delete personal information obtained from them, and, where applicable, to opt-out of the sale or sharing (i.e., disclosure for cross-context behavioral advertising) of their personal information (“CPRA Rights”). The Company’s Privacy Rights Policy explains that the Company does not, and will not, sell personal information and provides a detailed explanation of the right to know, the right to correct, and the right to delete. California residents who wish to submit a request to exercise one of the CPRA Rights can complete the following form to allow the Company to verify the requestor and to respond to the request.

California residents can also submit a request to exercise any of the CCPA Rights by contacting the Company at 877-956-2532 or at hr@pacifichomecare.com

Your Identifying Information:

Request #0






Your Relationship to Requestor:



If Authorized Agent, please sign and submit an Authorized Agent Designation Form here.

Your Relationship to the Company:

(You can choose more than one.)

Nature of Request:






Please provide additional information about the specific pieces of personal information that are the subject of your request: