Care request privacy notice

The request form collects your name, email, optional phone number, location, whether you have a prescribing provider, and, for providers, your practice name. It records your consent to be contacted and the treatment or partnership you selected.

Purpose of the request

This information is stored to help MIA coordinate a care or partnership conversation. It is not a medical record, prescription, appointment confirmation, or payment authorization. Do not include diagnoses, medical histories, identification documents, or payment details in this form.

Access and questions

Requests are not publicly visible. If you need to correct contact information or have privacy questions, use MIA’s existing contact channels listed on miacompounding.com. This notice describes this website’s contact form; it does not replace the pharmacy’s healthcare privacy notices.