Reporting of Technical Complaints

Reporting of Technical Complaints

Designation of Person Recording the Complaint*

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Company*

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Name of Pharmacy/Doctors Surgery*

Name of Person Reporting the Complaint*

Representative Name

Representative Email

Email Address - Customer*

Telephone Number - Customer*

Phone

Date Complaint is being reported*

Name of Product*

Strength of Product*

Pack size of product*

Batch Number of Product*

Expiry date of product*

Description of the complaint in detail*

Does the patient still have the product?

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Is the patient able to provide pictures*

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File Upload

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