Product Complaint - Western Cape Blood Service

Product Name*

Serial number of the unit*

Name and surname of complainant

First

Last

Email address of complainant*

Name and surname of recipient

First

Last

Hospital name and ward where recipient is at*

Hospital/Folder number of recipient*

Description of the complaint*

Date of complaint*

Blood Bank where the product was received from*

Important notice - Please return the product pack as well as the giving set to the Blood Bank

Are you human?*