CAPER Form

All reporters (including dermatologists, other physicians, and staff) who encountered a patient with an adverse event associated with a device, drug, cellular therapy/biologic, or surgical treatment should complete this form.

How to Report:

Method 1:

• Fill out and submit the online form by clicking here (https://caperphys.formstack.com/forms/caper_physician)
• If you need help filling out or submitting this form, you may call 312-695-6782 or email [email protected] 

Method 2:

• Submit this form electronically by doing a "save as" or scanning and email back to [email protected].
• If you are unable to submit this form electronically, you may fax it to CAPER at 312-695-0044.
• If you need help filling out or submitting this form, you may call 312-695-6782 or email [email protected]