Incident Reporting
This form is intended to help you report quickly to BII any
problem occuring with SwayStar™.
1.
Was the problem related to :
Software
Hardware
Test Subject (Patient)
2.
Please describe carefully the problem :
3.
Did you report the problem to your local Representative ?
Yes
No
4.
Your SwayStar™ serial number is :
5.
Your E-Mail address is :
6.
Confirm your E-Mail address:
7.
Confirm security code:
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© 2004-2014 Balance International Innovations GmbH
08.09.2014