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Privacy authorization form

A privacy authorization form allows an individual or organization to collect, use, and disclose personal information about another individual. The form must be signed by the individual whose personal information will be collected, used, and disclosed.

2 minutes to complete

Eligibility

Individuals who provide their personal data are eligible to fill the privacy authorization form.

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Questions for Privacy authorization form

Questions

1.

What information do you need from the user?

The answer should be a text input.
2.

How will you use this information?

The answer should be a text input.
3.

How will you protect this information?

The answer should be a text input.
4.

What is the name of the app that you are authorizing?

The answer should be a text input.
5.

What is the name of the company that owns the organization or application?

The answer should be a text input.
6.

What is the app’s primary purpose?

The answer should be a text input.
7.

Does the app or website collect, use, or disclose any personal information?

The answer should be a single choice:
  1. Yes
  2. No
8.

Does the app collect, use, or disclose any sensitive personal information?

The answer should be a single choice:
  1. Yes
  2. No
9.

Does the app collect, use, or disclose any financial information?

The answer should be a single choice:
  1. Yes
  2. No
10.

Does the app collect, use, or disclose any health information?

The answer should be a single choice:
  1. Yes
  2. No
11.

Does the app collect, use, or disclose any location information?

The answer should be a single choice:
  1. Yes
  2. No
12.

Does the app collect, use, or disclose any biometric information?

The answer should be a single choice:
  1. Yes
  2. No
13.

Does the app collect, use, or disclose any children’s information?

The answer should be a single choice:
  1. Yes
  2. No
14.

Does the app use any third-party services?

The answer should be a single choice:
  1. Yes
  2. No

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  • Consent to Disclosure of Health Information Form

Here are some FAQs and additional information
on Privacy authorization form

How long does it take to get my authorization form approved?

It can take up to two weeks for your authorization form to be approved.

How will I know if my authorization form has been approved?

You will receive an email notification when your authorization form has been approved.

Do I need to submit a new authorization form if I change my mind about what information I want to share?

Yes. If you change your mind about what information you want to share, you will need to submit a new authorization form.

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