If your complication is regarding a particular product, this incident form may need to be sent to the responsible company/manufacturer and may also be required to be sent to the Health Products Regulatory Authority (HPRA). By completing this form, you consent to releasing your details as you may need to be contacted to provide further details. ACE Group World will not disclose these details to any other person or organisation unless it is legally necessary to do so, although the anonymised data may be used.