Consent Withdrawal. If our use of your personal data is based on consent, you can withdraw that consent at any time.
Consent Withdrawal. At any time, you may withdraw your consent to the electronic delivery of your Documents. Please contact TruStone at 000-000-0000 and ask to change your statements back to paper. TruStone will not charge a fee to process your withdrawal of consent, but we may take a reasonable amount of time to process your request.
Consent Withdrawal. I understand I am able to withdraw my consent at any time by contacting Northpoint Pediatrics in writing at 0000 Xxxxxxxxxx Xxxxxxx, Xxxxx 000, Xxxxxxxxxxxx, XX 00000. Patient Name: _ DOB: _ CHART # Patient Name: _ DOB: _ CHART # Patient Name: _ DOB: _ CHART # Patient Name: _ DOB: _ CHART # Parent/Guardian name (Print): Parent/Guardian Signature: _ Today’s Date: _ _ _ _ Relationship to Child: Today’s Date: **Office Use Only – Form entered by Date entered This policy explains our practices regarding insurance billing, copayments, and patient billing. Your signature on the signature sheet confirms that you have read this policy and agree to be held financially responsible for all charges on your child’s account.
Consent Withdrawal. The sample donor has a right to withdraw from THL Biobank. In such a case, THL Biobank will inform the Recipient to exclude his/her material from the project, if feasible taking into account the nature and phase of the project and other relevant circumstances.
Consent Withdrawal. You have the right to withdraw your consent and require that we provide you with all Documents in paper form. However, withdrawal of your consent to receive electronic Documents may result in termination of your access to the Online Banking Service. Contact us at 000.000.0000 or by mail at 0000 Xxxx Xxxxx Xxxxxxxxx, Xxxxxx, Xxxxxxxx 00000 to withdraw your consent to receive electronic Documents. We will not impose a fee to process the withdrawal of your consent. Your withdrawal of your consent will be effective only after we have had a reasonable period of time to process your request. By clicking the “I have read, understood, and agreed to the Electronic Consent and the Consumer Online Banking Service Agreement” checkbox, you: (i) confirm your consent to receive Documents in electronic format; (ii) affirmatively demonstrate your ability to access the Documents in electronic form; (iii) confirm that you have provided a valid e-mail address at which we can send electronic Documents to you; (iv) have access to software and hardware that satisfies the above requirements;
Consent Withdrawal. You may change the scope of your authorization to continue to collect personal information or withdraw your authorization by deleting the configuration information, unbinding the associated device, or canceling the account number. Please understand that the service of business function shall require some basic personal information (registration e-mail), so if you withdraw your consent or authorization, we will stop providing the service corresponding to the withdrawal of consent or authorization. Yet, your decision to withdraw your consent or authorization shall not affect the processing of personal information previously based on your authorization. We shall reserve the right to modify the Privacy Agreement. Without your express consent, we shall not reduce your rights in accordance with the Privacy Agreement. Any change to the Privacy Agreement shall be posted on this page. For major changes, we shall provide more obvious notice (for certain services, we shall send an e-mail notification to state the specific changes to the Privacy Agreement). Major changes referred to herein include but are not limited to: • Major change of our service model, such as the purpose of processing personal information, and the type of personal information under processing, the way of using personal information; • Major change of our ownership structure, organizational structure, etc., such as owner change caused by business adjustments, bankruptcy mergers, etc.; • Major subject change of public disclosure of personal information; • Major change of your right to participate in the processing of personal information and the corresponding exercising methods; • Change of the department responsible for processing the security of personal information, or change of contact information and complaint receiving channels; • A high risk shown in the assessment report of personal information security impact. At the same time, we shall archive the former version of this Privacy Agreement for your reference.
