Privacy Request Form

Please complete this form if you wish to make a privacy-related request under applicable data protection laws (e.g., GDPR, CCPA).

If you use an authorized agent to submit a request on your behalf, we require the agent to provide their contact information and valid proof of authorization (e.g., signed written permission or power of attorney). We may also verify the agent’s identity directly with you before processing the request.

Download PDF

Submitting Your Written Request

Email the PDF to: [email protected]
Or mail it to: BlackDoctor Inc, Privacy Department, 309 W. Washington Street, Suite 250, Chicago, IL 60606
We will confirm receipt of your request within 10 business days (if required by law) and respond within the time required by applicable law (e.g., 30 days under GDPR, 45 days under CCPA/CPRA).
We will use the information provided to verify your identity and process your request.

1. Your Information

2. Type of Request

(Please check all that apply)


3. Details of Your Request

(Please describe your request in detail so we can process it accurately)

If your request concerns one of our AI-powered tools, it will help us locate your information if you tell us which tool you used and the approximate date of your session.

4. Verification

To protect your privacy, we may request additional information (such as a government-issued ID, proof of address, or documentation of authority if you are an agent) to verify your identity before fulfilling your request.

    Verification Agreement

    Authorized Agent Requests

    If you are submitting this request on behalf of another individual, please provide the following:

    Proof of Authorization: (please check one and attach supporting documentation)
      Authorization Confirmation

      Submitting Your Request

      We will confirm receipt of your request within 10 business days (if required by law) and respond within the time required by applicable law (e.g., 30 days under GDPR, 45 days under CCPA/CPRA).

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