SIDE EFFECT NOTICE

First Letter of Patient's Name *:

First Letter of Patient's Surname *:

Date of Birth (Day / Month / Year):

Gender of the patient:

Name and Surname of the Albila drug used *:

Other Drugs Used Together:

Adverse Reaction / Side Effect *:

Name of the person making the notification *:

E-mail of the person making the notification *:

Phone of the person making the notification *:

Albila Serum Biyolojik Ürünler San. ve Tic. A.Ş. Cumhuriyet Mh. İncirlidede Cd. ANTHILL Residence B Blok Apt No:6-1/41 Şişli İSTANBUL

Phone: +90 536 510 34 88
E-mail: info@albila.com