Adverse Reaction

For safety purposes and to provide feedback to the manufacturers, we require that customers fill out this form in order to be able to process a refund for the item that caused the reaction.

If you do not fill out the form, or if the information submitted does not match your order information, the item will not be refunded.

If your order contained multiple items, list and identify which item(s) caused the reaction.
Rash, itching, discoloration, etc...
Click or drag files to this area to upload. You can upload up to 5 files.
Upload pictures of the affected area.
I confirm that all the information is accurate and true.