Customer Complaints

Customer Information

Customer Name
Customer Address
Tel No. Cell No. Fax No.
Email*

Product Information

Product/s Involved
Batch Number/s: Expiry Date's: Shipment Date:
Brought Through: Quantity(s): Invoice No(s):
Received in proper condition (cold chain) Instruction Pamphlet Included Have instructions been followed

Complaint Details

Nature of Complaint*
Total number of animals involved: Total Dead Total Alive Total Pregnant
Total Aborted Species Age Sex
Symptoms Observed
Are all signs in same group of animals How long after administration did signs appear
Action taken after reaction

Treatment Details

Treatment given by owner/veterinarian Other treatment given: (Dipping/deworming/injections etc.)

Details of consulted veterinarian

Vet Name: Tel No.: Cell No.:
Address