California Privacy Contact Form

Please complete the information below to contact us regarding a privacy-related inquiry or request. All fields are required. If your inquiry or request is not related to a privacy concern, please go to our Contact Us page.

First Name*:

Last Name:*

Email*:

State*:

Do you have a Life Extension Customer Number?*

No Yes

Subject*:

For certain requests, we might ask you for documentation in order to verify your identity. We require proof of identity to prevent fraudulent requests involving attempts to harm others or to improperly suppress legal information.

Delete personal information

Know what personal information has been collected

Inquiry or request on behalf of*

If you are submitting this inquiry or request on behalf of someone else, we might ask you for documentation confirming you have legal authority to act on this person's behalf.

Myself

Spouse or family member

Client

Friend

Other

Does this inquiry or request concern an email that you received from us?*

Yes

I represent that the information I am providing on this Privacy Contact Form is accurate and that I am authorized to submit this inquiry or request. I understand that Life Extension might not be able to process my inquiry or request if this form is incomplete or inaccurate.

I consent to the processing of the personal information I am providing in this Privacy Contact Form and any personal information that I might provide in further correspondence for the purposes of processing my inquiry or request I acknowledge and consent to the transfer of the personal information in this Privacy Contact Form by Life Extension to its servers in the United States. I further acknowledge that Life Extension might transfer my personal information to its vendors and subcontractors in order to fulfill my inquiry or request.

* Required Fields