California Consumer Privacy Act

Notice of Financial Incentives Opt Out Request Form


The GuardianWell benefits may be considered a financial incentive under California law. If you are a California resident, you can use this form to submit an opt out of the GuardianWell benefits program. Please complete this form and we will respond as soon as possible.



Please indicate if you are submitting this request on your own behalf or on behalf of another individual as their representative.
Self (Consumer)
Representative on Consumer's Behalf
Enter the first name of the data subject
Enter the last name of the data subject
Insert your state of residence
Enter email for correspondence with the data request. Please review carefully to ensure your email is typed in correctly.
Please enter the number in the format NNN-NNN-NNNN