Description

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First Name*

Last Name*

Phone Number*

Email*

Select Your Closest Clinic

Please select the continence products you are currently using*:Intermittent catheters
Indwelling catheters
Urisheath/condom drainage with collecting bag
Absorbent products
Bowel Management
Other
None

Briefly Tell Us Your Areas Of Concern?

One of our Coloplast Care team members will call you shortly to discuss any identified issues. It isn’t easy to know if you need help to solve the problem from your GP or Specialist Nurse or if you can resolve the issue yourself.

Our Coloplast Care team are experienced in helping people solve continence issues. They are supported by our Clinical Nursing Team and are trained to give routine advice and recognise the signs that you may need to go back to a Specialist Nurse.

Please check the box to acknowledge that you have read and understood the Declaration of Consent.

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Thank you for your order