Contact - La Panzanella® Artisanal Foods Canada

Hidden

site_language

Feedback*

What type of feedback would you like to share?

Product Feedback: Reason*

Please select the specific reason for your feedback

General Inquiry: Reason*

Please select the specific reason for your feedback

Injury

Injury Details*

Please describe the injury you experienced. Please share as much information as possible.

Date*

When did this injury occur?

Medical Treatment*

Did you seek out medical treatment?

Yes
No

Product sample*

Did you still have a sample of the product?

Yes
No

Allergy

Illness / Allergy Details*

Please describe the reaction or symptoms you experienced

Food Allergies*

What food allergies do you have?

When did the reaction/illness occur?*

Duration*

Approximately how long did your symptoms last?

Other Foods Consumed

Please include all other foods that were consumed within 2 hours of eating the product.

Medical Treatment*

Did you seek out medical treatment?

Yes
No

Product sample*

Did you still have a sample of the product?

Yes
No

Foreign Material

Material Details*

Please describe the foreign material

Injury

Was an injury sustained from the foreign material?

Yes
No

Medical Treatment*

Did you seek out medical treatment?

Yes
No

Product sample*

Did you still have a sample of the product?

Yes
No

Product Information

Brand / Product*

Have you purchased this product before?*

Yes
No

Purchase Location

Best Before Date*

Note: the format on the packing is as follows: 191222 = YYMMDD Or December 22, 2019

Contact Details

Name*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Enter Email Confirm Email

Phone

Preferred contact method*

How may we contact you?

Comments*

Please enter your comments and feedback below

File

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 MB.

Mailing List

Keep me updated!*

WOULD YOU LIKE TO RECEIVE UPDATES ON PROMOTIONS, NEW PRODUCT LAUNCHES, RECIPE IDEAS, AND SPECIAL OFFERS, OR TO PARTICIPATE IN A SURVEY FROM LA PANZANELLA ARTISANAL FOODS?

Yes
No

May we use your comments?*

DO YOU PROVIDE PERMISSION FOR LA PANZANELLA TO USE COMMENTS IN THIS FORM FOR INTERNAL OR EXTERNAL MARKETING PURPOSES, INCLUDING ADVERTISING AND SOCIAL MEDIA?

Yes
No

Questions? Comments? We’d love to hear from you!

Injury

Allergy

Foreign Material

Product Information

Contact Details

Mailing List