Neoss Customer Complaint Form
Clinic/Customer details
Account number
Postal/Zip code
Clinic name
Email contact
Street
Contact name
City
Phone
Country
Please Select
Australia
Austria
Bahrain
China
Denmark
Germany
Greece
Hungary
Ireland
Italy
Japan
Jordan
Kingdom of Saudi Arabia
Kuwait
Lebanon
Libya
Netherlands
New Zealand
Norway
Oman
Poland
Portugal
Qatar
Serbia
Spain
Sweden
Switzerland
Syria
Thailand
Türkiye
United Arab Emirates
United Kingdom
USA
Product information
Article number
Article name
Batch/Lot number
Initial use date
(MM/DD/YYYY)
Date of problem
(MM/DD/YYYY)
Implant position
Add another product
Event description
Event type
Please Select
Osseointegration failure, before restoration
Osseointegration failure, after restoration
Implant fracture
Screw fracture
Abutment fracture
Instrument/accessories issue
Package, contamination or label issue
Instructions for use
No primary stability
Other
Event description
Did the event lead to any of the following: Patient death, life-threatening illness, or permanent impairment of a body function?
Please Select
Yes
No
Did the device cause or contribute to the event?
Please Select
Yes
No
Was implant restored with Neoss original prosthesis?
Please Select
Yes
No
Prosthesis type
Please Select
Single crown
Partial bridge
Full arch bridge
Overdenture
No prosthesis
Temporary or permanent prosthesis
Please Select
Temporary
Permanent
No prosthesis
Patient information
Oral hygiene
Please Select
Excellent
Good
Average
Poor
Medical History
Smoking
Diabetes
Periodontitis
Osteoporosis
Medication affecting healing
Radiotherapy
Bruxism or clenching
SUBMIT COMPLAINT