Privacy Rights Request Form

MHA Privacy Rights Request Form

Managed Health Care Associates, Inc. (“MHA”) honors privacy rights afforded to individuals under applicable privacy laws. This Privacy Rights form enables you to submit a request to know and access your personal information collected by us, correct inaccurate information about you, or delete personal information we collect about you. It also allows you to opt out of the sale or sharing of your personal information.


If you are interested in submitting a Privacy Rights request to MHA under applicable privacy laws, you may fill out the form or email us at If you are submitting a request on behalf of another individual, please select “Someone Else” and provide us with documentation showing you are authorized to act as the individual's agent.


Note: please select “Do Not Sell or Share My Personal Information” in the form if you wish to opt out of sharing of your personal information with our third-party partners or for cross-context behavioral advertising / targeted advertising. Also, please be aware that a Deletion request may affect our ability to execute other rights requests that you subsequently make or are otherwise still being processed at the time such Deletion request is fulfilled. For multiple requests, we suggest that you submit requests other than a Deletion request first and wait until they are processed before submitting a Deletion request.


To learn more about how MHA handles personal information, please visit our Privacy Policy. We will use the information you provide only to process your request and maintain a record of your request. If you have questions regarding this form or need assistance for accessibility, please contact us at

Please provide a detailed explanation of the incorrect personal information you wish to be corrected and the correct information.

Or Power of Attorney Email Address, when applicable.