patient opt-out request form

If you do not want your information shared by PelEX, you can opt out at any time by:

  • Filling out the brief Patient Opt-Out Form below, or
  • Calling us at 504-301-9835

When you submit the form below, PelEX will be notified of your request.

MM slash DD slash YYYY
Reason for Opting-Out

This field is for validation purposes and should be left unchanged.

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Visit the Patients & Families section to see if we have already answered your question!