Start my request

Sign up and authorize us to request removal of your data from health-data companies on your behalf. We'll file the requests and track them.

Who you are

Full legal name

Former / maiden name(s)

Date of birth

Where you've lived

Why addresses matter here Data brokers match your records mostly by address history, not by name alone. It's the single biggest factor in whether we can actually find your data at a given company. This information is never sold or shared, and it's only ever used to file the specific requests you've authorized. You'll see exactly what's sent to each company before anything goes out.

Current address

Prior address(es) (optional)

Entirely optional, but each one you add meaningfully improves how much of your data we can find. No pressure to be complete. Even one or two helps.

State of residence

Also used to autofill the state in your current address above.

How to reach you

Phone number(s)

Email address(es)

Authorization

I authorize Optava to act as my agent and file delete / opt-out / know requests on my behalf.

Type your full name to sign

Signing creates a timestamped record of the exact text you agreed to, plus your IP address and a unique confirmation ID: a real audit trail, not just a name typed into a box.