Compliant Form

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PFC Complaint Form

Please fill out the compliant form below and a member of the PFC staff will be in touch in the next 3-5 business days with resolution information.


 

Name of Company (required)

Mailing Street Address (required)

City (required)

State (required)

Zip (required)

Complaint Description
Describe in detail the specific complaint or action desired. Please include what requirements the company does not meet. Example include misuse of logo, labeling errors, non-compliance with state or local regulations, etc.

The complainant named below, if other than regulatory agencies, patient, caregivers or licensed health care providers, agrees to bear all costs of the investigation if the complaint is unsubstantiated and deemed invalid.

Name of Contact (required)

Position (required)

Organization (required)

Phone Number of Contact (required)

Contact Email (required)

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