Data Subject Request Form

To exercise your rights under Article 11 of the KVKK, you can submit a request using one of the methods below, in line with the Communiqué on the Procedures and Principles of Application to the Data Controller. Your request must include the information we need to verify your identity.

How to apply

Method	Address
Signed letter, in person or through a notary	Gürselpaşa Mah. Şehit Polis Şahin Polat Aydın Cad. No:1, Merkez Plaza, Kat 11, Daire 50, 01200 Seyhan / Adana
Registered electronic mail (KEP), secure e-signature or mobile signature	kvkk@ayselpelit.com
From the email address registered with the clinic	kvkk@ayselpelit.com

Please write “Request for Information under the Personal Data Protection Law” on the envelope or in the email subject line.

Information to include

• Name, surname and signature (for written requests),
• National ID number (for foreign nationals: nationality and passport or ID number),
• Residential or business address for notifications,
• Email address and phone number, if any,
• The subject of your request.

Request form

Print and complete the form below, or send a letter containing the same information.

Field	Details
Name and surname
National ID / passport no.
Address
Phone
Email
Your relationship with the clinic	☐ Patient ☐ Patient’s relative ☐ Visitor ☐ Other:
Your request	☐ Whether my data is processed ☐ Information about my data ☐ Correction ☐ Deletion ☐ Third parties it was shared with ☐ Objection ☐ Compensation
Details
Preferred reply method	☐ Post ☐ Email ☐ In person
Date and signature

Requests are answered as soon as possible and within thirty days at the latest, free of charge. If the request involves additional cost, the fee set by the Personal Data Protection Board may apply.