Revoke HIPAA Authorization
The purpose of this webform is to revoke your prior authorization for Color to disclose health information. For this form to constitute a valid revocation, it must be completed and submitted by the subject individual or their parent/guardian. This revocation of authorization will not affect any action Color or any other entity took in reliance on the authorization to disclose health information prior to the date of Color’s receipt and processing of this revocation.
Thank you for your submission. You should receive an email at the address provided confirming your revocation was submitted. Please note that it may take Color up to 5 days to process this request.