Report a Side Effect – Wishing Well Health

Important: If you are experiencing a serious or life-threatening reaction, call 999 immediately. This form is not monitored in real time.

Your full name *

Your email address *

Order number (if known)

Date side effect started

How severe is it? *

Please describe what happened *
Include symptoms, when they started, and how long they lasted.

Any action taken so far?
e.g. stopped medication, contacted GP, visited A&E

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