Reaction Form

Product Name

Batch/Serial Number (If Applicable)

Purchase Date:

Customer Name

Contact Email

Value is required

Date and Time of Use

Description of Reaction:

Affected Area

Medical Professional's Name (if applicable)

Treatment Received

If so, when (Date).

Please provide any additional information or comments that you believe may be relevant.

Form submitted. Please email photos to info@absoluteskin.com.au

Currency