Consumer Access Request Form

We focus on offering a high quality, service-oriented environment for your surgical procedure.

Consumer Access Request Form

Name*
Date of Birth*
Month
Day
Year
Telephone Number*
Address*
City*
State*
Zip Code*
Email*
If you do not have an email address, please type "none". Fields with * are required
Information Being Requested
- Specific pieces of personal information, collected or shared with third parties and for what business/commercial purpose.
- Request to delete data.
We do not sell personal information that we have collected from consumers to any third parties. By completing this form, you are making a Consumer Access request under California Consumer Privacy Act for personal information collected, held and disclosed about you that you are entitled to receive. On this date , I affirm that I am the consumer, or authorized by the consumer to act on their behalf. I understand that misrepresentation may be subject to legal action.
CAPTCHA

GET IN TOUCH WITH TETON OUTPATIENT SERVICES

CLICK TO CONTACT US

Contact Info

Address

150 Buffalo Way

Jackson, WY 83001

Phone Number

(307) 733-8677

Hours

Monday - Friday 7:30am – 4:30pm
Weekends CLOSED

You are now leaving Teton Outpatient Services

Teton Outpatient Services provides links to web sites of other organizations in order to provide visitors with certain information. A link does not constitute an endorsement of content, viewpoint, policies, products or services of that web site. Once you link to another web site not maintained by Teton Outpatient Services, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy.

You will be redirected to

Click the link above to continue or CANCEL