Erasure Request Form

By submitting this form, you are requesting that HEALTHCARE COST RESEARCH GROUP deletes all of your personal identifiable information from our records. This includes, but is not limited to: First Name, Last Name, Contact Email Address(es), and Phone Number(s); Name of Insurance, Location of Service (e.g. Facility or Hospital, City, State, etc.), Medical Service Received, and Rendering Provider; as well as other specifics related to your healthcare coverage.

FOR ALL PAID PARTICIPANTS: Please note that HEALTHCARE COST RESEARCH GROUP will need to keep some of your personal identifiable information for our financial records.