ADVERSE DRUG REACTION REPORTING FORM

For VOLUNTARY reporting of ADRs

ALIGENTIS COSMETOLOGY Helpline : +91 8558880915 (10:00 AM to 6:00 PM, Monday-Saturday)

Patient Information
Event Description
Drug Use Detail
Treatment Dates
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Reporter Information

If you prefer to submit your report by mail, download the reporting form and send the completed form to the address below.

Aligentis Cosmetology Pvt. Ltd.

Registered Office:
SCO-4, 2nd Floor, Mansa Devi Complex, Sector 5, Panchkula, Haryana 134114

Phone: +91 8558 880915
Email: aligentiscosmo@gmail.com

Adverse Event Reporting

To report an adverse event, we recommend contacting our Pharmacovigilance team using the email address provided above. If additional information is required, our team will get in touch with you.

Aligentis is committed to maintaining the highest standards of patient safety. All adverse event reports are reviewed in accordance with applicable pharmacovigilance regulations to help monitor the safety and benefit-risk profile of our products.

Who Can Report?

  • Healthcare Professionals (Doctors, Dentists, Nurses, Pharmacists, etc.)
  • Patients, Caregivers, Relatives, or Consumers

Confidentiality

All personal and medical information provided will be treated as strictly confidential and handled in accordance with our Privacy Policy and applicable data protection regulations.

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