Submit a privacy request or complaint online
Use our online forms to make a privacy request or file a complaint.
Make a privacy-related request
You have the right to exercise the following actions.
Request to authorize a representative to access protected health information (PHI).
Complete the PHI authorization form on the Member resources page.
Request an accounting of disclosure.
Request an amendment your record.
Request confidential communications.
Request records.
To make a request, send an email to privacy@libertydentalplan.com. Include your name and the details of your request.
