Privacy Web Form

Welcome to the Exact Sciences Privacy Request Web Form for Authorized Agents

You can use this form to submit a California Consumer Privacy Act (CCPA) request on behalf of another individual. Please complete the information requested below and we will respond as soon as possible.

If a Consumer is submitting a request through an authorized agent, such authorized agent must be registered with the California Secretary of State and must provide us with the Consumer's signed written permission stating that the agent is authorized to make the request on the Consumer's behalf. We may also request that any authorized agents verify their identity and may reach out to the Consumer directly to confirm that the Consumer has provided the agent with permission to submit the request on their behalf. We may deny a request from an agent that does not submit proof that they have been authorized by the Consumer to act on their behalf.

For more details and information about how we use and protect personal information, visit our Privacy Notice for California Residents.

I am submitting this request on behalf of another individual as:

Required

Requestor Information

Please complete this section of the form with your information so we may contact you about the request.

Requestor First Name

Requestor Last Name

Requestor Email

Enter email for correspondence with the data request.

Consumer Information

Please complete this section of the form with information about the California Consumer for whose data you are inquiring.

Request Type

Required

Select the Exact Sciences’ product the Consumer has interacted with

How would you describe the Consumer's relationship with Exact Sciences?

First Name

Enter the first name of the data subject

Last Name

Enter the last name of the data subject

Date of Birth

Phone Number

Address

City

Zip

I confirm the foregoing information I have provided is accurate.

Please attach below either a certified and signed declaration from the Consumer authorizing you to act on the Consumer's behalf or a valid power of attorney.