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Contact Us
Product Quality Complaint Form
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Oh yes, we’d love to hear from all of you!
Complainant Information
Salutation
Select one...
Mr.
Mrs.
Pharm
Pharm Dr.
First Name
Last Name
Email Address
Phone number
Address
Product Information
Product Name
Product Description
(Include dosage form, strength and pack size, if available)
Batch #:
(leave blank if batch no is not known)
Expiration Date:
(MM-YYYY)
Is the product available for return?
Yes
No
Complaint Details
Description of Complaint
Complaint Source
Consumer
Pharmacist
Physician
Warehouse
C&F
Regulatory
Not Available
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