data privacy request form

Data Privacy Request Form

Name (include maiden, if applicable, and indicate if you are an authorized agent):(Required)

First Last

Relationship to Corcept, Past or Present (employee, contractor or candidate for employment, vendor, or patient):

Phone

Email(Required)

Request Type (check all that apply):(Required)

Request to obtain (access) the categories of personal information Corcept has collected, used, sold, disclosed, or shared with third parties about you

Request to obtain (access) the specific data fields of personal information Corcept collected about you

Request to correct (rectify) information held about you

Request to delete (erase) personal information held about you

Request to restrict processing of your information

Request to opt-out of the sale of your personal information (Please note Corcept does not generate revenue by selling Personal Information)

Request for your data to be removed from any automated decision-making processes

Other (please explain in the additional details section below)

Additional Request Details:

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