Description of Complaint:
Walgreens Privacy Office, 200 Wilmot Road, MS 9000, Deerfield, Illinois 60015
Phone: (847) 236-6518 Fax: (847) 236-0862
[Revised: 04/05/2007]
COMPLAINT FORM
Procedure
To file a privacy complaint with Walgreens or one of its subsidiaries, please complete and submit this form electronically or mail a
copy of this form to the Privacy Office at the address listed below.
Information Required
We take privacy and the resolution of your complaints seriously. As part of our privacy practices, there will be no retaliation for filing
a complaint. In order to fully investigate this matter, please complete the following areas by providing specific details as they pertain
to your complaint:
Date:
Time:
Location: Store: Store Address:
City, State, Zip:
Mail Order (select one): Orlando, Florida / Tempe, Arizona / Portland, Oregon
Internet (select one): www.walgreens.com / www.walgreenshealth.com
Other: (please specify)
Name of Employee Involved (if known):
Information:
I request additional communications from Walgreens regarding the resolution of this issue.
I do not request additional communications from Walgreens regarding the resolution of this issue.
Your Name:
Street Address:
City, State, Zip:
Day Telephone: ( )
E-mail Address:
Evening Telephone: ( )
Phone: (847) 236-6518; Fax: (847) 236-0862.
Your Signature
Mail this completed and signed form to: Walgreens Privacy Office, 200 Wilmot Road, MS 9000, Deerfield, Illinois 60015;
Signature:
Date:
