Consumer Privacy Request Form

Depending on where you live, you may have specific rights regarding your personal information that Brookdale has collected and used.

Only residents of California, Colorado, Connecticut, Delaware, Nevada, New Jersey, Oregon, Texas, Virginia, or Washington can make a request using this form. Residents include individuals living in a state and those domiciled in a state but temporarily outside of the state for a temporary or transitory purpose. This also includes residents seeking Brookdale services in the state of Washington.

Please note that some third-party website cookies may constitute a “sale” of personal information under applicable state law. In addition to opting out of the sale of personal information not associated with cookies through the below form, you also may opt out of some third-party website cookies by clicking the “Cookies Settings” link at the bottom of the page here. If you choose to exercise your right to delete personal information obtained, then your experience on www.Brookdale.com may change, with less customization and personalized features.

AUTHORIZED AGENT REQUESTS

California, Colorado, Connecticut, Nevada, Oregon, Texas, Virginia and Washington residents may designate an authorized agent to make a request on their behalf. We will deny requests from agents that do not submit proof of authorization from you. To verify that an authorized agent has authority to act for you, we may require a copy of a power of attorney or require that you provide the authorized agent with written permission and verify your own identity with us.

Response to Requests

To ensure your request is fulfilled properly, please fill out the form as thoroughly as possible. After submitting the form, you’ll receive a confirmation email to the email address provided.

We will verify your identity. You will need to provide us with certain information such as your name, email address, physical address, or other information, as relevant, so we can verify that you are who you say you are. Which information may depend on the type and sensitivity of information requested.

We will confirm our receipt of your request within 10 days. If you have not received a response within a few days after that, please let us know by contacting us 1-800-236-3454 or emailing us at partner@brookdale.com.

We will respond to your request as described above in Brookdale’s Privacy Policy.

First Name *

Last Name *

Email Address *

Email Address 2

Home Phone *

Work Phone

Mobile Phone

Address

Address 2

City

State or Province *

Zip or Postal Code

List any social media handles to remove:

Please select and describe your request here in detail:

Comments