Skin Safety Report

Product Experience Report

Your safety and experience are our highest priority. Please use this form to report any unexpected reactions or concerns. Our team will review your submission promptly and confidentially.

About You

Full Name*

Email Address*

Phone Number

About The Product

Product Name*

Batch Number / Lot Code*

Found on packaging

Where did you purchase the product?*

About The Experience

Date the reaction began*

Please describe the experience/reaction*

Where on the body did it occur?*

Face

Neck

Chest

Hands

Other

Have you consulted a healthcare professional?*

Yes

If yes, what was their advice?

Consent & Submission

By submitting this form, you consent to us using the details provided to investigate your experience and improve our product safety. All information is kept strictly confidential.