Print the form and fill in with all information you have on the adverse drug reaction. If you are the doctor please confirmed it with signature and stamp.
- Adverse drug reaction to doctor notification form
- Adverse drug reaction to patient notification form
Please, transfer the form to our Company representative or send it to the address below:
Bausch Health Poland sp. z o.o.
ul. Przemysłowa 2
faks: + 48 44 789 00 36
You can also notify the adverse drug reaction by phone or email:
+ 48 724 182 068