Complaint form

(filled by the optician’s)

    ComplaintPart purchase







    Claimed part: (Required)

    FrontRight templeLeft templeBoth templesFlexDecorative elementLensClip-onWholeOther

    Reason for the complaint: (Required)

    Broken templeChippingUnsolderingCrackLoss of colourScratchCrookedDamaged threadOther

    Is it enough to replace the flex

    YESNO

    Attach photo (Required)

    I agree to the processing of my personal data in accordance with the contents of the General Regulation on the Protection of Personal Data of 27.04.2016 and in accordance with the Act of 18.07.2002 on the provision of electronic services (Dz.U. No 144, item 1204, as amended) by IQ Prisma sp. z o.o. with its registered office at ul. Turawska 14A, 46-022 Zawada for the purpose and to the extent necessary for the preparation and transmission of the complaint application sent to the controller using the above complaint form.

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