Faulty product feedback form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Are you a: *Customer, Carer or External representativeBrightSky employeePlease choose 1 of the above options that best describes you.Customer Name *FirstLastBrightSky customer number (If known)Sales order or Invoice number (If known)Customer contact phone number *Customer contact email address *Product item number and description *Affected quantity *Batch number (If can be located)Has this product fault impacted your health in any manner? *YesNoHealth concerns experienced as a result of the product fault *When was the fault noticed?Images of the fault, expiration date. and lot number where possible. Click or drag files to this area to upload. You can upload up to 5 files. Please provide images of the fault and where possible, include the Lot number and Manufacturer’s expiration date.Sharing of contact and delivery information *Yes – Customer | User agrees to share contact and delivery details with the supplier.No – Customer | User does not wish to share contact and delivery details with the supplier.Contact details will help us and our suppliers to troubleshoot and resolve the issue as quickly as possible.SAP Sales channel for the order (BrightSky Employee Only)Employee Name *FirstLastFeedback StatusOpenClosedPlease Note:Do not destroy or discard your product, BrightSky or our supplier will contact you to discuss next steps Submit
