We want to know if you are experiencing an adverse reaction or injury related to the use of a product; however, any information added to this form will not result in medical care or treatment. If you are having a health issue, please remove the product and contact a medical professional immediately. After speaking with a medical professional, please provide details related to your adverse reaction or injury.
Please provide any other details, as needed. If no other details are needed, please type N/A in the box