CCPA Request Submission Form

If you are a California resident, you have certain rights under the California Consumer Privacy Act (“CCPA”). Please use this form to submit a CCPA-related consumer request relating to any of your personal information held by PetVet Care Centers (“PetVet”, “we”, “our”, “us”).

Note that PetVet reserves the right to refuse requests, in part or in whole, to the extent permitted by law, if we are unable to verify your identity, or if we cannot verify your authority to act on behalf of another person. For certain requests, we may ask for additional information or documentation to verify your identity and/or authority to act on behalf of the consumer who is the subject of the request.

For additional information about the CCPA and your rights thereunder, please visit our Privacy Policy here.

Consumer Information

First Name *

Middle Name

Last Name *

Date of Birth *

Phone Number *

Email Address *

Street Address *

City *

State *

Zip Code *

Authority to Submit Consumer Request

Please select: *

I am making this consumer request related to personal information about me.

I am acting as an authorized agent for the consumer named above. I have attached a California Authorized Agent Designation form completed and signed by the aforementioned consumer.

FILE UPOAD: Authorized Agent Designation Form (click on the link below to browse and upload): *

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Specify Request(s) 

Check All Applicable: *

Request to know categories of personal information PetVet has collected, used, disclosed, and/or sold about the consumer.

Request to obtain specific pieces of personal information PetVet collected about the consumer.

Request to delete personal information PetVet has collected about the consumer.

Request to opt out of the “sale” of personal information about the consumer.

By submitting this form, I hereby certify that the information entered into this form is complete, accurate, and up-to-date, and that I am the consumer who is the subject of the request or have been authorized by that consumer to act on his/her behalf, as indicated above. I understand that it may be necessary for PetVet to verify the identity of the consumer and/or authorized agent for this request, and additional information or documentation may be requested for this purpose.

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