Washington consumers can use this form to make a request under the Washington State My Health My Data Act relating to personal health information, subject to applicable law.
Please select the appropriate request type below. If you want to select more than one request type, you must submit a separate form for each request type. This information will only be used to process your request. We may contact you to verify your identity in accordance with applicable law.
If you are not a Washington consumer and submit a request through this form, below, it may be rejected.