In case of complaints relating to product quality we kindly ask you to fill out the form below or call us. All information you provide will be treated as strictly confidential. Product information Product name * Dosage form and strength* Manufacturer* Batch number* Expiry date Does product appearance correspond to information in the pack insert?* ---YesNo Description of product defect* Source of information Contact person* E-mail* Telephone* Address What is the source of the product (pharmacy, distributor, doctor, other) Your comments Type the symbols * Required fields
