Personal Data Removal Request Form

According to certain privacy laws like GDPR, you can say no to Acute Doctor using your personal data.

Fill out this form to do that

Make sure to answer everything on the form truthfully and completely. Acute Doctor might check other sources to confirm what you say. They'll follow the law to balance privacy and free speech.

Just because you submit a request doesn't mean Acute Doctor will delete your info from their platform. They might not process incomplete forms.

Your information

Please provide your complete legal name, even if you are representing someone else, you must have the legal right to do so.

First Name*

Last Name*

Email*

Please provide an email address we can use to contact you about your request.

Country whose law applies*

Please select the country whose law applies. Typically your country of residence.

I am acting on behalf of...*

Legal Relationship

Please describe your legal relationship to the person on whose behalf this request is being made.

Data subject's information

Please provide the full legal name for the subject of the request (the data subject). If you are completing this request on behalf of yourself, please provide your own full legal name.

Data subject's first name*

Data subject's last name*

Public figure*

Is the data subject a public figure (politician, celebrity, etc)?

Yes

Public figure contextIf the data subject is a public figure, please describe the data subject’s role in society or their community.

Evidence of data processing

Relevant prompts*Please provide any relevant prompts that resulted in the model mentioning the data subject. To be able to properly address your requests, we need clear evidence that the model has knowledge of the data subject conditioned on the prompts. The information requested is necessary to allow us to determine the correct balance of interests, rights, and freedoms and what is in the public interest.

Screenshots of relevant examples / generations*

Please provide screenshots of relevant examples / generations of the model mentioning the data subject's data information.

Sworn statements

Please read the following statements and check the boxes to confirm that you have read and acknowledge them.
Acute Doctor will use the personal data provided through this form and related correspondence to process your request and comply with our legal obligations. For further information about our use of personal data please read our full Privacy Policy.

I have read and acknowledged the explanation above of how the personal data that I am submitting will be processed.*

I represent that the information in this request is accurate and that I am authorized to submit this request.*

I understand that Acute Doctor may not be able to process my request if the form is not properly filled out, or if the request is incomplete.*