Report your adverse incident
Fill out the following form to report any adverse incident that has happened with one of our products. Please be as clear and detailed as possible.
Product
*
RenehaVis (Hyaltech LTD)
Route of Administration (YES APPLICABLE)
*
Incident date
*
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Lote
*
Adverse incident
*
Patient Name
*
Email
*
Phone
*
Do you agree to be contacted?
*
Yes
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