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Pink Poppy Flowers

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Product Issue Form

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Product Name / Strain*

Dispensary Where Purchased*

Describe the Issue (What happened? When did you notice it?)*

Photos of the Product Issue*

Photo of Full Receipt*

Photo of the Compliance Label*

Have you used any of the product? (if yes, how much remains?)**

Consent & Acknowledgment

“I confirm the information is accurate and understand Firelands Scientific may share limited details with the dispensary to resolve my request.”

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