Thousandlashes Adverse Effect Questionnaire  (1) Logo
  • Thousandlashes Adverse Effect Questionnaire

  • Section A- Consumer/Contact Information

  •  - -
  • Section B- Details Of Event

  •  - -
  •  - -
  • Section C – Product Availability

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Section D - Relevant Tests/Laboratory Data

  •  - -
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Your health information cannot be used or shared without your written permission unless the
    law allows it. Please use the following link for more information on the HIPAA Privacy Rule:

    https://www.fda.gov/safety/reporting-serious-problems-fda/hipaa-compliance-reporters-fda-medwatch

  • Should be Empty: