Fill out the form below and show the 'thank you page' to your barista to get your FREE beverage!

State/ Territory*







Please select the continence products you are currently using*:






I would like to join the Coloplast Care program for intermittent catheter users
Order consent declaration

If you are having any difficulties submitting your form, please refresh the page and re-fill your details in the mandatory fields.

Want to know more about the Coloplast Care program for intermittent catheter users? 
Click here.

Close

Free sample - Free shipping

Thank you for your order

Confirmation

View desktop version