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Customer Testimonial Submission Form

We appreciate your feedback regarding our products.  If you would prefer to contact 
us by phone, please call 888-RECLUSE during normal business hours..

Fill out the below form to submit your comments
 

Name:

Date Bitten:
Email Address:

City/State: 
 
Do you have any photos of the bite wound (e.g. Before/after)?
Yes  No
 
Do we have your permission to use your testimonial on our web site and/or submission to clinical studies so that others may benefit?
  Yes    No
 
 
Please give us the format for using your name in the comments:

Full name and location (e.g. Jane Doe, Tulsa, OK)

First name, last initial and location (e.g. Jane D, Tulsa OK)

First initial, last initial and location (e.g. J D, Tulsa OK)
 

Your Comments:

 

Please E-mail any pictures to testimonialpictures@brownrecluses.com


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Questions? Contact our Brown Recluse response team at
(888) RECLUSE

(888) 732-5873

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PO Box 1255 Ava, MO 65608