Do Not Sell Information Request Form

Please read before submitting this form:

��91��only sells information relating to nephrologists as part of our ��91��Source initiative. If your information was not gathered on DaVitaSource.com/Contact-Us, please know that your information will not be sold and you will receive a denial to your submission.

If you meet the above criteria, please completely and accurately submit the following information so that we may process your request.

First Name:

Last Name:

Email:

State:

Practice or Fellowship Program:

Message:

Information about your right to request

��91��will confirm receipt of your request within ten (10) days and provide additional information on how your request will be processed. ��91��may ask for additional information to verify your identity or confirm your request, as required by CCPA.

An authorized agent may submit a request on your behalf; however, ��91��reserves the right to request (a) that you verify your identity, and (b) written proof that you have permitted the authorized agent to act on your behalf.

For additional information about DaVita's privacy practices and your rights under CCPA, please review DaVita’s Privacy Policy.

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Do Not Sell Information Request Form

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