REQUEST TO WITHDRAW PERsONAL INFORMATION

Please provide the information necessary to identify and remove your personal information from our volunteer database.

If you do not wish to complete the form below, you are able to request a withdrawAL of personal information via telephone, email or in person.

Phone: 519-344-6612

Email: info@bwresearch.ca

In Person: Bluewater Clinical Research Group, 481 London Road, Sarnia ON N7T 4X3

(Located on the Main Floor Beside Dr. Michael O’Mahony’s Office)

Name

First Name

Last Name

Email Address

Message

We appreciate your feedback and are committed to improving the experience of all volunteers. If applicable, please provide information as to why you would like to be removed from our volunteer database.

Please check the box below if you wish to withdraw your personal information.

I wish to remove all personal information stored by Bluewater Clinical Research Group and to opt of out of further communication.

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