Quality Defect Complaint Form Quality Defect Complaint Form We would like to hear from you. Please send us a message by filling out the form below and we will get back with you shortly. Quality Defect Complaint Form Type of Report Primary Follow Up Name of medical Dept. contact person Date Primary Reporter’s Information Name * Title * Profession * Phone No * Address * Fax * Customers Information Initials Profession Address Customers Information Initials Profession Address Out come and possible relatedness of drug Drug(s) Information Brand Start date Lot Expiry Date Comment Details of Quality Defect “Defect Summary Description”: Details of Quality Defect “Defect Summary Description”: If you are human, leave this field blank. Submit Δ
