Complaint Form

In case of a complaint, please fill out the attached form.

Practice Name *

Street *

Post code *

City *

Country *

Name of implantologist *

E-Mail *

Personal evaluation requested

Date of Event *

Event description (including comments) *

Patient/User injured? *

Patient-ID/Initials *

Age

Health factors *

Hold Ctrl/Cmd to select multiple

Other medical factors

File Attachments

Drop file(s) here or click

I confirm that I have read and understood the applicable SDS warranty terms . *

I confirm that I have uploaded a photo of the affected product and, if available, pre- and postoperative X-ray images *

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Frequently asked questions

Complaint form instructions