Product Complaint Form

Contact Information

Title(Required)

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Job Title/Position(Required)

Company Name (if applicable):

Product Information

Product Name:(Required)

Part Number / SKU / REF(Required)

Lot/Batch Number(Required)

Purchase Date(Required)

Complaint Type(Required)

Detailed Description of the Issue

Was Patient Involved ?(Required)

If Yes, Please Describe Any Patient Effects:

Other

Product Usage Details

Date of Incident(Required)

Usage Type(Required)

First Use

Repeated Use

Additional Information

Action Taken by User (if any)(Required)

Is Product Available for Return?(Required)

Yes

Photo Upload (optional):

Max. file size: 2 GB.

Upload any relevant photos of the product or issue, if available

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.

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Product Complaint Form

Contact Information

Product Information

Product Usage Details

Additional Information

Acknowledgment

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