Mecapharma

Complaint Report Form

Product Information

Product Name

Batch Number

Product Quality Affected

Complainant Information

Name

Address

Position (Patient, his/her relative or
Customer…)

Company Name (If Applicable)

Phone

Complainant Information

Country were the Claim is due from

Date of incident (DD/MM/YY)

Is the Complaint related to Product Distribution?
Is the Complaint related to Product Quality?

Description of incident covered by the Claim

Attach Photo of the issue (If Possible)

Download Offline Form

For complaints, please fill up the Complaint form and click on Submit.
You may print the form, whether empty, partially filled or filled.
Forms may be faxed to +961 4 444 275.
Forms may be printed here, scanned and mailed to quality@mecapharma.com otherwise call our hotline on +961 76 115 444.