We'd love to hear from you.

For general inquiry please call us at 844-MED-GLUE or send us an email.
If you have used our products, we’d love to know your feedback.

GENERAL FEEDBACK FORM

Name

Phone Number

Name of Health System

Address of Health System

Additional Feedback or Comments

The instructions were clear and easy to follow

The product was easy to apply

The drying time met my expectations

The patient experienced discomfort

The product performed as expected

Overall, I am satisfied with the product

Select product name from the list:

If you are human, leave this field blank.

REPORT PRODUCT INCIDENT

Name

Phone Number

Name of Health System

City & State of Health System

Describe Incident in Detail

When did the incident occur?

Provide best contact for follow up questions (Name, Email, Phone etc..)

Was a patient impacted by the incident?

Yes

Provide lot number for affected product

Select product name from the list:

Is product available for return and analysis?

Yes

If you are human, leave this field blank.