Good Neighbor Pharmacy Product Complaints & Adverse Events
For questions or issues with Good Neighbor Pharmacy private label products please fill out the form below. For inquiries regarding a specific pharmacy or pharmacist, please contact your local pharmacy directly.
Name:
*
First Name
Last Name
Email contact address:
*
example@example.com
Phone number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Pharmacy where the product was purchased:
*
Pharmacy address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Product Description (name/strength etc.):
*
Description of complaint or adverse event (Please be as specific as possible and attach photo of the event, if available, in the attachment field below):
*
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Date of event occurrence:
*
-
Month
-
Day
Year
NDC Number or UPC Number as applicable:
*
Batch/Lot Number of Product:
Date of Expiry of Product:
-
Month
-
Day
Year
Affected Product Quantity:
Submit
Should be Empty: