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Legal

uTransplant Privacy and Consumer Health Data Request Form

Form version: August 19, 2026

Use this form to submit a privacy or Consumer Health Data request to Bridge Clinical Care PLLC, operator of uTransplant. You may submit a request without creating or signing into an account.

Do not enter medical records, Social Security numbers, government-identification numbers, complete payment-card information, passwords, or detailed health information in this form. If additional documentation is reasonably necessary to verify your identity or authority, we will provide a separate secure method and the Secure Privacy-Request Verification Notice, including the purpose and retention rules, before you upload it.

Submitting this form does not change your marketing preferences. We will use the information provided here only to authenticate, evaluate, fulfill, document, and communicate about your request; maintain security; prevent fraud; and comply with law.

Also see our Privacy Policy and Consumer Health Data Privacy Policy.

1. Person making the request

Are you submitting this request for yourself? (required)

2. Service involved

Select all that apply:

3. Request type

Select all that apply:

4. Information needed to understand the request

0/2000

Do not include medical records, passwords, government identifiers, complete financial information, or unnecessary health details.

6. Verification and declaration