Notification of Complaint

Notification of Complaint

Please submit form as soon as possible (preferably within 24 hours of issue)
Date Closed

MonthDayYear
Date
SOP-026-F01
Date

MonthDayYear
Today's Date
If you are a Distributor, please give the following information: Company Name, Address, Email, and Phone Number.
Please fill in Customer information below
Name

First NameLast Name
Name of Veterinary Hospital/Clinic/School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Source of Complaint

Other
Item Number
Lot Number(s)
Product Purchase Date

MonthDayYear
Date
Do you still have the product?
How did you purchase the product?

Distributor; please provide name
Was the product used?

Reused; How many times?
Was the Product Cleaned and/or Sterilized?

Yes; What method(s) were used?
Is this the first time your establishment has used this type of product from MILA International?
When did the issue occur?
Describe the issue you are having with as much detail as possible
Attach photos, videos, or other supporting documents below.
File Upload

Cancelof
File Upload

Cancelof
File Upload

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File Upload

Cancelof
- SOP-026-F01
- Evaluation Details
  Procedure:
  Quality:  Type a label
  Labeling:  Type a label
  Sterility:   Type a label
  Other:   Type a label
- Product returned to MILA International?
- If Yes RGA # / If No give Reason:
- Investigation Required?
  
  No; Reason:
- Details of Investigation
- MILA Lot Number(s) Affected
- Manufacture Lot Number(s) Affected
- Investigation Completed By
  
  First NameLast Name
- Date
  
  MonthDayYear
  Date
- Investigation Approved By
  
  First NameLast Name
- Date
  
  MonthDayYear
  Date
- CAPA Documents
  
  Cancelof
- Othe Supporting Documents
  
  Cancelof
- SOP-026-F03
- Replacement(s) Sent?
- Invoice Number for Replacement(s):
- Credit Memo Number (If Applicable):
- Check Method(s) used to Close Complaint
  
  Other
- Notes
- Were Preventive Corrective Actions used because of the Complaint?
  
  No; Reason
- Communication to the Customer Required?
- Date of Final Response to Customer
  
  MonthDayYear
  Date
- Notes:
- Complaint Closed By
  
  First NameLast Name
- Will delete anything below at a later date
  
  If we delete now, it deletes it from all currently submitted forms
- Complaint Type
- Date Closed
  
  MonthDayYear
- Should be Empty:

Notification of Complaint

SOP-026-F01

Attach photos, videos, or other supporting documents below.

SOP-026-F01

SOP-026-F03

Will delete anything below at a later date