CCPA Consumer Data Subject Request

Under the California Consumer Privacy Act (CCPA), California residents are entitled to make certain requests regarding the personal information that Rotech Healthcare Inc. holds, shares, or uses about them.

Additionally, Rotech does not sell personal information, but under Nevada SB 220 you are entitled to make a request not to sell your personally identifiable information. Please review Rotech Healthcare Inc.'s Privacy Policy for further information on what information we collect and why we collect it.

If you are a California or Nevada resident and would like to submit a request under CCPA or SB 220 respectively, please complete the form below. We ask that you provide this information so that we can verify your identity and respond to your request.

Residency:(*)

These laws apply to residents of California and Nevada.

Consumer Information

Complete Name:
Invalid Input

Any other name(s) that you are known by:
Invalid Input

Street Address:
Invalid Input

City
Invalid Input

Zip Code:
Invalid Input

Email Address:
Invalid Input

Phone Number
Invalid Input

Global ID Number:
Invalid Input

Type of Request

I am requesting the following:

Invalid Input

Verification:(*)

Please read and agree to the statement.

Please type the letters:(*)
Please type the letters:
Invalid Input