DATA SUBJECT REQUEST FORM
Prof. Dr. Hasan Göçer Clinic would like to inform you that you have the rights granted to data subjects as specified in Article 11 of the Personal Data Protection Law No. 6698 (“the Law”). In accordance with Article 13 of the Law, our Clinic, acting as the data controller, has published the “Information Notice on the Protection of Personal Data” on its website at https://hasangocer.com.tr, which details the conditions for the processing of personal data, data security, and the procedures and principles for data destruction on its website at https://hasangocer.com.tr in the “Information Notice on the Protection of Personal Data.”
RIGHTS OF DATA SUBJECTS
You may submit the following requests using the Application Form:
- To find out whether your personal data has been processed,
- If your personal data has been processed, to request information regarding such data,
- To learn the purpose of the processing of your personal data and whether it is being used in accordance with that purpose,
- To know the third parties to whom your personal data has been transferred, whether within the country or abroad,
- Request the correction of your personal data if it has been processed incompletely or incorrectly,
- To request the erasure or destruction of personal data processed in accordance with the law and regulations, should the grounds justifying its processing no longer exist,
- To object to a decision made solely through the automated analysis of processed data that results in a negative outcome for you,
- To request compensation for damages suffered as a result of the processing of personal data in violation of the Law.
HOW TO SUBMIT A REQUEST
Requests to be submitted to our Clinic, which acts as the data controller pursuant to Articles 11 and 13 of the Law:
- In writing to the address Hakkı Yeten St. No. 11/13, Şişli / Istanbul, or via a notary public,
- via email to info@hasangocer.com.tr, using the email address you previously provided to our Clinic and which is on file.
APPLICANT INFORMATION
| Field | Information |
| First Name | |
| Last Name | |
| Turkish ID Number | |
| Passport Number (if foreign) | |
| Residential / Work Address | |
| Phone Number | |
| Email Address |
YOUR RELATIONSHIP WITH THE CLINIC
Please indicate your relationship with our clinic:
☐ Patient ☐ Family Member ☐ Visitor ☐ Supplier ☐ Former Employee ☐ Job Applicant ☐ Other: ___________
REQUEST
Please describe the nature of your request:
RESPONSE TO YOUR REQUEST
Please specify how you would like to receive a response to your request:
☐ I would like it sent to my home or work address.
☐ I would like it sent to my email address.
☐ I would like to pick it up in person.
Applicant (Data Subject)
First Name Last Name: ________________________________
Application Date: ________________________________
Signature: ________________________________
Data Controller: Prof. Dr. Hasan Göçer
Address: Hakkı Yeten St. No. 11/13, Şişli / Istanbul
Phone: +90 532 604 02 44
Email: info@hasangocer.com.tr
Website: https://hasangocer.com.tr
