Adverse Reaction Form

Please provide as much information as possible to ensure our team can find the best solution for you.

DISCLAIMER: THIS FORM DOES NOT PROVIDE MEDICAL ADVICE

No material contained in this message is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and never disregard professional medical advice or delay in seeking it because of something you have read here.

Your Name *

Phone Number *

Email *

Order number *

Product Batch Number- Please include one number for each product *

Located on the bottom of Quench, Illuminate and Enrich outer bottles/ the top seam of Rinse tube

Which KaramMD products have you used and how long had you been using them when the reaction occurred? *

Which of the products do you believe caused the adverse reaction? *

Please provide a detailed account of how the products were used before the reaction occurred. *

Please provide a detailed description of what you experienced during the reaction including areas affected ( e.g. redness/swelling around the eyes).

Have you received any medical treatment for the adverse reaction? *

If yes, please describe the treatment you received and from whom.

Do you have any known allergies or irritants? *

If yes, please list them here.

Had you received any treatments around the time the reaction occurred (facial, laser, peel, waxing etc)? If yes, please specify which treatment and when you received it.

Have you ever experienced this reaction with a similar product in the past? *

If yes, please provide the brand and name of the product.

Are you using any other brands/products besides KaramMD? *

Is there any additional information you would like to share?

Please attach photos of your skin before and after reaction.

Before *

Choose file or drag here

Supported format: JPG, JPEG, PNG, GIF, SVG.

After *

Choose file or drag here

Supported format: JPG, JPEG, PNG, GIF, SVG.

In providing this information to KaramMD, and ticking this box I acknowledge and agree that: KaramMD is collecting this information as part of its quality and safety management and product innovation process and/or to enable it to process the return of a product.

Agree

After submitting this form please allow 3-5 business days for someone from our customer support team to be in touch with next steps.

Thank you for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thank you for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

We would like to hear from you.

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