DATA SUBJECT REQUEST FORM

Welcome to the National Eating Disorders Association’s (“NEDA,” “we,” “us”) Data Subject Rights Request form. Please provide the information requested below to the best of your ability. If you have already received any correspondence from us, please provide your information as it appears in the correspondence you received from us. We will respond to your request as required by applicable state or federal law. Depending on the nature of your request, we may need to contact you for additional information for verification purposes. Please note that your email address is required in order for us to provide final confirmation on how your request was handled. Personal information provided in this form will only be used to process your request. For additional information regarding your privacy rights, see our website at: www.nationaleatingdisorders.org/.

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1. Are you making a request for yourself or on behalf of someone else? (Required.)

Myself

On behalf of someone else

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2. I am submitting a (please see our website privacy policy [https://www.nationaleatingdisorders.org/privacy-policy/] on what rights that apply depending on your residency): (Required.)

Request to Know/Access

Request to Delete

Request to Correct

Request to Data Portability

Request to Limit Processing of Sensitive Data

Request to Do Not Sell or Share Personal Data

Request to Opt Out of Targeted Advertising

Request to Opt Out of Automated Decision-Making Activities Including Profiling

Request to Withdraw Consent

Please describe your request [or submit information in the upload box below]

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3. Please select your state of residency (Required.)

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4. I am (Required.)

A patient

A health care professional

An employee, job applicant, or former employee

A caregiver

Other

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5. First Name (Required.)

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6. Last Name (Required.)

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7. Email Address (Required.)

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8. Confirm Email Address (Required.)

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9. Phone Number (Required.)

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10. Country (Required.)

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11. State (Required.)

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12. Address (Required.)

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13. City (Required.)

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14. Zip or Postcode (Required.)

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15. Upload File

For additional information regarding your privacy rights, please visit our website at www.nationaleatingdisorders.org

DATA SUBJECT REQUEST FORM

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* 1. Are you making a request for yourself or on behalf of someone else? (Required.)

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* 2. I am submitting a (please see our website privacy policy [https://www.nationaleatingdisorders.org/privacy-policy/] on what rights that apply depending on your residency): (Required.)

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* 3. Please select your state of residency (Required.)

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* 4. I am (Required.)

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* 5. First Name (Required.)

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* 6. Last Name (Required.)

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* 7. Email Address (Required.)

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* 8. Confirm Email Address (Required.)

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* 9. Phone Number (Required.)

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* 10. Country (Required.)

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* 11. State (Required.)

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* 12. Address (Required.)

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* 13. City (Required.)

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* 14. Zip or Postcode (Required.)

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* 15. Upload File

1. Are you making a request for yourself or on behalf of someone else? (Required.)

2. I am submitting a (please see our website privacy policy [https://www.nationaleatingdisorders.org/privacy-policy/] on what rights that apply depending on your residency): (Required.)

3. Please select your state of residency (Required.)

4. I am (Required.)

5. First Name (Required.)

6. Last Name (Required.)

7. Email Address (Required.)

8. Confirm Email Address (Required.)

9. Phone Number (Required.)

10. Country (Required.)

11. State (Required.)

12. Address (Required.)

13. City (Required.)

14. Zip or Postcode (Required.)

15. Upload File