COSMETOVIGILANCE

Adverse event or product problem

We offer our consumers cosmetic products that are safe and compliant with current regulations. However intolerance to some of the contained ingredients cannot be excluded.

If any undesirable effect occurred after the application of the cosmetic product, we kindly ask you to fulfil the following form.

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COSMETOVIGILANCE

Costumer information

* required fields

Name and surname: *

Age: *

Gender: *

Nationality: *

City: *

Address:

Email: *

Phone: *

Adverse event or product problem

Type of report: *

Outcome attributed to Adverse Event: *

(Select a multiple options)

Death

Date of death: *

Life-threatening

Hospitalization

Other serious or important medical events

Required intervention to prevent permanent impairment/damage

Disability or permanent damange

Congenital anomaly/birth defects

Other disease/health issue

Date of event: *

Describe event or problem: *

Additional comments:

Suspect product

I have read, understood and accept the privacy policy*.