Health Product Complaint Form (FRM-0317)

Protected when completed and received by Health Canada. Treasury Board Secretariat Government Security Policy.

Report

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Who is reporting

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Privacy Notice

The personal information you provide to Health Canada is governed in accordance with the Privacy Act. We only collect the information we need to administer national compliance and enforcement activities for health products under Health Canada’s mandate authorized under the Food and Drugs Act.

Purpose of collection: To contact you for additional information regarding your complaint and/or, with your consent, follow up with or refer your complaint to another organization outside Health Canada .

Other uses or disclosures: In limited and specific situations, your personal information may be disclosed without your consent in accordance with subsection 8(2) of the Privacy Act.

For more information: The collection of your personal information is described in Info source. Refer to the personal information bank (PIB): Compliance and Enforcement - Natural Health Products (HC PPU 406), Compliance and Enforcement - Pharmaceutical Drugs (HC PPU 407), and Compliance and Enforcement - Biologics & Radiopharmaceuticals (HC PPU 408).

Your rights under the Privacy Act: In addition to protecting your personal information, the Privacy Act gives you the right to request access to and correction of your personal information. For more information about these rights, or about our privacy practices, please contact Health Canada's Privacy Coordinator at 613-948-1219 or privacy-vie.privee@hc-sc.gc.ca. You also have the right to file a complaint with the Privacy Commissioner of Canada if you think your personal information has been handled improperly.

Incident/Complaint


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Product

Enter the product details and information regarding the manufacturer and where it was purchased. To enter additional products, click on the "Add Product" button. To remove one product and its related information, click on the "Remove Product" button.

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Manufacturer of the Product

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Where was the Product purchased

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