Product Complaint Form 1. Contact InformationFull Name(Required)Email Address(Required) Phone Number(Required)Company Name (if applicable):2. Product InformationProduct Name:(Required)Part NumberLot/Batch NumberPurchase Date MM slash DD slash YYYY 3. Description of ComplaintComplaint Type(Select the type of issue)Product DefectPerformance IssueSafety ConcernLabeling or Packaging IssueOther (Please specify)OtherDetailed Description of the IssueWas Patient Involved? Yes No If Yes, Please Describe Any Patient Effects:4. Product Usage DetailsUsage Type First Use Repeated Use Date of Incident MM slash DD slash YYYY 5. Additional InformationAction Taken by User (if any)Is Product Available for Return? Yes No Photo Upload (optional):Max. file size: 2 MB. Upload any relevant photos of the product or issue, if available6. Acknowledgment By submitting this form, you confirm that the information provided is accurate and that you understand Makvin Surgical may contact you for additional information to support our investigation and quality improvement efforts.Consent By checking this box, you agree to our Terms and Conditions and Privacy Policy.
