Haven Well Within

Right To Appeal

To exercise your right to appeal Haven Well Within decision to fulfill your request, please complete and submit this form.

In order for us to identify you and verify the request in accordance with applicable law, please provide the following information: Your first name, your last name, your address (including zip code), email, phone number, Customer ID (if available) and any additional information that may assist us in locating data you believe Haven Well Within is in control of.

In order to complete your request, we require your email and phone number. If you do not have both, please call Customer Service at 1-833-HAVENWW (1-833-428-3699).

Please provide us with as much information as possible regarding your appeal in the box below. If you previously received communication from us indicating we were unable to locate or verify your information and you DID NOT reply with the requested information, please use the box below to provide any alternate name and/or address that may assist us in locating or verifying you..

      

Please note that by submitting this form, you are exercising your Right to Access your personal information. We will respond to your request as soon as possible, but no later than 45 days from our receipt of your request (unless we determine that we need additional time to respond, in which case we will notify you).