Digital Health App Subscription Cancellation
Submit your request to cancel your digital health app subscription. Please complete all required fields to ensure prompt processing.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name of the Health App
*
Subscription Plan/Type
*
Please Select
Monthly
Annual
Trial
Other
Subscription Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Cancellation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Cancellation
*
No longer needed
Too expensive
Found a better alternative
Technical issues
Privacy concerns
Other (please specify)
Please share any additional feedback or comments
Signature
*
Submit Cancellation Request
Submit Cancellation Request
Should be Empty: