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Product Return

Noticed any product faults?

Should you notice any product faults, please report the product batch information found on the product label. Tell us what happened. If possible, please keep the affected product sample so that we can get it collected from you. We will investigate and come back to you!
DD slash MM slash YYYY
(who is completing this form?)
(this information is on the product label)
(this information is on the product label)
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(this information is on the product label)
Contact Name(Required)
Email(Required)
Address(Required)

Product Fault

Product component defect(Required)
(which product component was defective? Select all that apply. If possible, please keep the affected product so that we can get it collected from you for detailed investigation).

Product Use

Place of Use

The product was used in the following clinical environment
(select all that apply)

Incident

(to help us process your information quickly and effectively, please include the following information in your reporting: - Any injuries and/or Harm? - What is the issue you experienced? - Is the actual sample available? )

When can we talk to you?

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Consent
This field is for validation purposes and should be left unchanged.