Coloplast Care Direct referral form

Seamless support for every one of your clients' journeys

In partnership with you, Coloplast Care Direct gives your clients access to NDIS guidance, fast and reliable product delivery, and nursing and wellbeing support - while easing your admin and ensuring continuity of care. Together, we give your clients the confidence to live more comfortably and independently.

We can support you with unbranded NDIS justification letters backed by clinical evidence, which have a 75% success rate on the first submission¹. Up to six months of FREE NDIS product Gap Fill* gives your clients peace of mind - they have what they need, when they need it. Enjoy hassle-free ordering and delivery, with calls answered within 30 seconds². Plan-managed NDIS orders are released before invoices are paid and delivered within a few days, not weeks.

It’s confident care, made easy. That’s Care Direct.

Clients Details

First Name*

Last Name*

Contact Number*

Referring Clinician's Details

First Name*

Last Name*

Clinician's Facility*

Contact Number*

Email*

Please tick if you’d like us to provide

I would like a Justification Letter prepared by a Coloplast Nurse

I would like supporting clinical evidence for the prescribed products provided in an editable Word document

Please enter your clients upcoming review or planning meeting date: (DD/MM/YYYY)

Please list the Coloplast products your client is wanting to purchase (including sizes/codes where possible):

Consent and Privacy Statement

I consent to registering my client for Coloplast Care services (including Care Direct)Yes

The client listed above has given their consent for me to provide their details for the purpose of delivering Coloplast services. Coloplast Pty Ltd collects personal information about your client, including information about their health or a relevant medical condition. The information we collect may be used to determine which Coloplast products and services are suitable for them and contacting them with further information about these products and services. If we do not collect this information from you, we may not be able to provide them with information about suitable Coloplast products and services. When we first speak to the client, we will ensure that they also agree with this statement. Further detail about how we collect, use and disclose personal information is available in our Privacy Policy at www.coloplast.com.au/Global/Privacy-policy. You may also contact us on 1800 333 317Yes

contactUsBysendUsEmail

Reference:

1. Coloplast, Data-on-File, Coloplast Internal Survey, Nov/2025, Sample size [n=15]. (Based on Internal analysis of Justification Letter outcomes, April–November 2025.)

2. Coloplast, Data-on-File, Coloplast Internal Data Analysis, Oct/2025, Sample size [n=16,908 calls]. (Based on inbound call data: Average Speed of Answer (ASA) – Consumer team, Feb–Oct 2025, Genesys Cube and Analytics Workspace.)

*Terms and conditions apply. For further queries relating to eligibility and the scope of the Gapfill supply, please contact our Consumer Care Team by phone on 1800 653 317 (freecall) or by email at aucaredirect@coloplast.com.

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Coloplast Care Direct referral form

Seamless support for every one of your clients' journeys

Thank you for your order