CONTACT US

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.

This field is for validation purposes and should be left unchanged.
MM slash DD slash YYYY
Reason for Opting-Out

Are you contacting us with a question?

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