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VITASMART COMPLAINT FORM - MEDICA SPA
Active Medical Device (AMD)
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* Indicates required question
Name (individual/company)
*
Your answer
E-mail address
*
Your answer
Phone
Your answer
Country
*
Your answer
Third party complaint reference (if any)
Your answer
Origin of the complaint - part 1
Hospital/Clinic
Distributor
Company
Organization
Hospital/Clinic
Distributor
Company
Organization
Clear selection
Origin of the complaint - part 2
Doctor
Paramedic
QC
Other
User
Doctor
Paramedic
QC
Other
User
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Other information regarding the Sender
Your answer
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