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ABOUT US
DOCTORS
PHARMACISTS
OUR PRODUCTS
FLOWERS
ORAL LIQUIDS
VAPE CARTRIDGES
RESOURCES
CONTACT
Feebacks
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Date of Complaint
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Person Affected
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First
Last
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
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Bahrain
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Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
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Bulgaria
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Burundi
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China
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Cook Islands
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Cyprus
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Ecuador
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Eritrea
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Panama
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Tanzania, the United Republic of
Thailand
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US Minor Outlying Islands
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Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
Phone
Product Name
Batch Number
Expiry Date
Product Size
10g Jar
28g Jar
30ml Oral Liquid
Complaint Type
Adverse Event
Presentation/Appearance Defect
Packaging or Label Fault
Underweight Product
Performance/efficacy Issue
Other - Please Describe
Date product received
MM slash DD slash YYYY
Please tell us how and when you identified the complaint
Pharmacy/Dispensary Product Obtained From
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