ODL Complaint Ticket Form

Please use this form to inform us about any issues, complaints, concerns, or general feedback you'd like to make. This form is not for new customer inquires.

First name*

Last name*

Email*

Company name*

Ticket name/ Issue*

Please state the name of the issue, statement or concern

Category*

Product issue or Complaint

Billing issue

Ticket description*

Please be as specific as possible when describing your issue or concern

File upload

If your issue is with a specific product, please upload clear photos of the product issue

Prescription ID

If your issue is regarding a specific prescription please state RX ID #