Complaint Registration Form


    Customer name / Company


    Contact details

    (Please provide at least an e-mail address)


    Product name and item number


    Lot number or serial number (if available)


    Description of the issue


    Number of affected units (pieces)


    Used on patient?


    Was anyone injured?


    Attached documentation (photos, reports, etc.)



    You will receive a confirmation e-mail after submitting this form.