This English translation is provided for information only. The legally binding version is the Turkish original.
This form was prepared for you to exercise your rights under Article 11 of the Turkish Personal Data Protection Law No. 6698 (KVKK). You can print and fill in the form, or write a petition containing the same information. Details on how your data is processed: KVKK Privacy Notice.
Do not include health information unless necessary. For a request concerning your examination record, it is enough to state the approximate date of the record; we will find the details in our records.
Application channels
- In person or by post, with a wet-ink signature: Op. Dr. Hüseyin Efe Akalın, Ege Mah. Turgut Özal Bulv. Cadde Residence A2 Blok Kat: 3 Daire: 10, 09400 Kuşadası/Aydın, Türkiye
- Email: info@huseyinefeakalin.com. You can send it from the email address you have previously given us and that is in our records, or sign it with a secure electronic signature or mobile signature.
Your application is concluded free of charge, as soon as possible depending on its nature and within 30 days at the latest. If the process requires an additional cost, a fee according to the tariff set by the Personal Data Protection Board may be charged. To verify that the application belongs to you, we may call you on your registered phone number or ask for additional information.
1. Applicant’s details
| Information | |
|---|---|
| Name and surname | |
| Turkish ID number (if you are a foreign national, nationality and passport or ID number) | |
| Notification address | |
| Phone | |
| Email (if any) |
If you are applying on behalf of someone else (parent, guardian, attorney), also write your own details and attach the document of authority (power of attorney; the part of the guardianship decision showing the appointment of the guardian; for your child, an extract from the civil registry).
| Representative details | |
|---|---|
| Name and surname | |
| Turkish ID number | |
| Nature of representation |
2. Your relationship with the practice
- ☐ I contacted the practice or received services (for myself or for the person I represent)
- ☐ I am a website visitor
- ☐ Other:
3. Your request
- ☐ I want to learn whether my personal data is processed.
- ☐ If it has been processed, I request information about it.
- ☐ I want to learn the purpose of processing and whether it is used in line with its purpose.
- ☐ I want to know the third parties in Türkiye or abroad to whom my data has been transferred.
- ☐ I request correction of my data that has been processed incompletely or inaccurately.
- ☐ I request the deletion or destruction of my data.
- ☐ I request that the correction, deletion or destruction be notified to the third parties to whom my data has been transferred.
- ☐ I object to a result against me arising from analysis carried out exclusively through automated systems.
- ☐ I request compensation for the damage I have suffered due to unlawful processing.
- ☐ I withdraw the explicit consent I have given.
Explanation (briefly describe your request; do not include health information):
4. How would you like to receive the response?
- ☐ By post to my address
- ☐ To my email address
- ☐ By hand delivery
5. Declaration
I declare that I am making this application for myself or on behalf of a person I am authorized to represent, and that the information I have provided is accurate and up to date.
| Form date | |
|---|---|
| Name and surname | |
| Signature |
The application date is the date on which the application reaches us. Your application is kept for the purpose of responding to it and, where necessary, for use in legal proceedings. If your application is rejected, if you find the response insufficient, or if no response is given in time, you may file a complaint with the Personal Data Protection Board within 30 days from the date you learn of the response and, in any case, within 60 days from the date of application.
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Last updated: October 29, 2026