Health Supplement Incident Report Form
Please fill this form to report any incidence of poor quality health supplements or adverse health events that occurred after using a health supplement. The details submitted through form will be kept confidential.
The name and photo associated with your Google account will be recorded when you upload files and submit this form.
Part-I: Reporter Details
Your Name
Address
Phone Number
E-mail
Your Profession
Part-II: Product Details
Please provide the details of the health supplement below.
Brand Name *
Batch No. *
Manufacturer Details (Include address) *
Part-III:The Actual Report
Report here your experience
Please describe the events associated with Health Supplements (experienced a side effect, discontinued prescription medicines, contracted an illness etc) *
Please upload a photograph of the product if you have one right now.
Submit
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This form was created inside of Royal Government of Bhutan. - Terms of Service