CASP
Scheme Information
Prescribers
Pharmacists
Contact Us
Scheme Information
Prescribers
Pharmacists
Contact Us
CASP
Little Green Pharma Cannatrek Customer Feedback Form
This form is for feedback or complaints relating to Little Green Pharma or Cannatrek sponsored products. Information provided will support the investigation of the reported issue and ongoing improvements to our products and internal processes.
Important: This form must be completed by the dispensing pharmacy, prescriber or consignment partner.
Medical concerns:
Patients should discuss any medical concerns relating to their treatment or medication with their prescribing doctor or dispensing pharmacy. If a serious side effect is suspected, seek medical attention immediately. For emergencies, call triple zero (000). If too much medicine may have been taken, contact the Poisons Information Centre on 13 11 26, available 24 hours a day.
Today's Date
REPORTED BY
Full name
(Required)
Organisation type
(Required)
Pharmacy
Consignment partner
Prescriber / Clinic
Other
Organisation / Business name
(Required)
Contact number
(Required)
Country
Phone Number
Email address
(Required)
We may contact you using these details regarding your submission and any next steps.
PURCHASE DETAILS
Where was the product purchased from?
(Required)
Greenship
Other Distributor / Wholesaler
Distributor / Supplier name
(Required)
Invoice number (if available)
PRODUCT DETAILS
Product name
Batch number
Expiry date
Date dispensed
Has the product been opened / used?
Yes
No
Is the product available for return?
Yes
No
What is the product feedback relating to?
(Required)
Adverse event or medication reaction
Damaged product or packaging
Product quality concern (e.g. appearance, smell, taste, texture or consistency)
Leaking, broken or faulty container/device
Incorrect quantity / product appears underfilled
Foreign matter or suspected contamination
Labelling or packaging concern
Other
FEEDBACK DETAILS
Please provide a detailed description of the feedback or complaint
SUPPORTING INFORMATION
For perceived faulty products, please provide available images of the product, packaging and/or issue with this form.
Images provided
Drop files here or
Select files
Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 128 MB, Max. files: 4.
Anything else you'd like to let us know?
Privacy acknowledgement
(Required)
I acknowledge that Cannatrek, Little Green Pharma and their related entities may collect, use and retain the information provided in this form for record-keeping, follow-up and related business purposes. For more information, please refer to our
Privacy Policy
.