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Codex Labs Corp
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Skin Concern
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Mists & Toners
Soaps & Soaks
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Antü® Collection
Bia® Collection
Shaant Collection
Decode Collection
About
Our Mission
Skin Quiz
Sustainability
Blog
Decode.me
Providers
Skin Concern
Skin Concern
Eczema
Dry / Sensitive
Acne / Oily
Skin Barrier
Psoriasis-Prone
Rosacea-Prone
Products
Products
Supplements
Cleansers & Masks
Moisturizers
Serums, Oils, Eye & Lip
Mists & Toners
Soaps & Soaks
Bundles
Gift Cards & Events
Collections
Collections
Antü® Collection
Bia® Collection
Shaant Collection
Decode Collection
About
About
Our Mission
Skin Quiz
Sustainability
Blog
Decode.me
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Complaint Record Form
Name of Product as it appears on the box, bottle, or package*
Batch number (if applicable)
Expiry date (if applicable)
Date of purchase (DD / MMM / YYYY)
Type of supply
Retail
Online
Other
Name
Company
Address
Email
*
Phone
Classification (if applicable)
Packaging defect (e.g. packaging broken or tampered)
Product defect (e.g. odour, physical properties such as viscosity, colour and deformation)
Undesirable Effect (e.g. allergy, irritation)
Other
Duration of use / application
Did you use any other cosmetic products (including make-up) on the day of occurence?
Yes
No
Do you use any anti-aging or acne products on a daily basis
Yes
No
Have you had a facial or other facial cosmetic treatment (e.g. masks, peels, dermabrasion) in the last ten days
Yes
No
Have you recently exfoliated your skin or used any topical products (i.e. creams, gels, serums, washes) containing Alpha Hydroxy Acids (AHAs) (e.g. glycolic, lactic acid), Beta Hydroxy Acids (BHAs) (e.g. salicylic acid) or products containing retinol or benzoyl peroxide in the last ten days
Yes
No
Do you use any products containing essential oils or fragrances on a daily basis?
Yes
No
Was a doctor, pharmacist, or other healthcare professional consulted?
Yes
No
If yes, please specify if symptoms were treated and how:
Any other information
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