Leading Regeneration
Customer acknowledgement form
Please complete this form even if you do not have any affected stock.
PRODUCT NOTIFICATION
TGA Recall Reference Number: RC-2019-RN-00543-1
Product name: Geistlich Bio-Oss Pen®
All (in-date) Batches
0.5cc, 1cc, and 1.5cc Applicators with Green or Red Cap.
On behalf of this organization I acknowledge receipt of the Geistlich Bio-Oss Pen® notice dated 04/04/2019 relating to the above product.
FROM:
| Organization | |
| Position | |
| Name | |
| Email or fax no. | |
| Telephone no. | |
| Date |
Bio-Oss Pen® Stock
If you have no Bio-Oss Pen® stock, tick this box
If you have Bio-Oss Pen® stock, please complete the stock details table below.
| Product Code | Quantity of unused stock |
|---|---|
| 500081- Bio-Oss Pen® 0.25-1mm, 0.25g o.5cc | |
| 500082 – Bio-Oss Pen® 0.25-1mm, 0.5g 1cc | |
| 500083 – Bio-Oss Pen® 1-2mm, 0.5g 1.5cc | |
| Total Bio-Oss Pen® stock |
Please Complete the acknowledgement form even if you do not have any Bio-Oss Pen® stock and return it to info@geistlich.com.au or FAX 1800709698 to reconcile this process.