Problem Order Form

Report an issue with an order. Pick the affected product(s) and issue type, add details and photos, then submit. Once reviewed and approved, a Problem Order is created in Salesforce.

1 Details

2 Products

3 Issues

4 Review

Customer Details

All fields marked with * are required.

Email *

First Name *

Last Name *

Phone

Order Number

Which product(s) have an issue?

Select all that apply — even if you ordered a bundle, pick only the item(s) with a problem.

Affected product(s) *

Tell us about the issue

For each product, choose the issue type and add details.

Send the customer an automated "need more info" email

Review & Submit

Please confirm the details below before submitting.

While Remi (through shopremi.com or direct communication) may provide general information and/or recommendations, content is provided for informational purposes only and should not be construed or treated as medical advice. If you are experiencing an oral health issue or have questions that are medical in nature, if you wear braces, dentures or other dental appliances that may be loose, old, or damaged, and /or if you have any loose, old, or damaged teeth, crowns, implants, or fillings, please consult with your health care provider before using Remi. Remi products are not intended for use by anyone under the age of 18. Remi does not knowingly allow or collect personal information from children. If you are a parent or guardian and you are aware that your child has provided Remi with personal information, please contact us. If you have any questions, please contact Remi at support@shopremi.com. If your concerns are dental-related, please contact your primary dental professional.

Account