Continence Sample Kit - samples to be sent to the patient

Please select the required product(s) and enter both the patients and your details below.

All kits are sent with product information and continence education materials.

*Required fields

Intermittent Catheters
A maximum of 10 catheters per person in total will be sent
SpeediCath Compact SetCompact Set Female 12Fr/750mL Compact Set Male 12-18Fr/750mL	SpeediCath CompactSpeediCath Compact Female (7cm) 10Fr SpeediCath Compact Female (7cm) 12Fr SpeediCath Compact Female (7cm) 14Fr SpeediCath Compact Plus Female (9cm) 10Fr SpeediCath Compact Plus Female (9cm) 12Fr SpeediCath Compact Plus Female (9cm) 14Fr SpeediCath Compact Male (30cm) 12-18Fr	SpeediCath Flex (33cm)SpeediCath Flex double loop 10Fr SpeediCath Flex double loop 12Fr SpeediCath Flex double loop 14Fr SpeediCath Flex single loop 10Fr SpeediCath Flex single loop 12Fr SpeediCath Flex single loop 14Fr SpeediCath Flex single loop 16Fr
SpeediCathSpeediCath Paediatric 6Fr SpeediCath Paediatric 8Fr SpeediCath Female 10Fr SpeediCath Female 12Fr SpeediCath Female 14Fr SpeediCath Male 10Fr SpeediCath Male 12Fr SpeediCath Male 14Fr SpeediCath Male 16Fr SpeediCath Male 18Fr	EasiCathEasiCath Female 8Fr EasiCath Female 12Fr EasiCath Female 14Fr EasiCath Male 10Fr EasiCath Male 12Fr EasiCath Male 14Fr EasiCath Male 16Fr EasiCath Male 18Fr	Self-CathSelf-Cath Paediatric (25cm) 6Fr Self-Cath Paediatric Lure End (25cm) 8Fr Self-Cath Paediatric Lure End (25cm) 10Fr Self-Cath Female (16cm) 10Fr Self-Cath Female (16cm) 12Fr Self-Cath Female (16cm) 14Fr Self-Cath Male (40cm) 10Fr Self-Cath Male (40cm) 12Fr Self-Cath Male (40cm) 14Fr Self-Cath Male (40cm) 16Fr Self-Cath Male (40cm) 18Fr

Urisheaths/Uridomes
A maximum of 7 sheaths per person in total will be sent along with the bag options selected
Conveen Optima urisheathConveen Optima Standard (8.5cm) 25mm Conveen Optima Standard (8.5cm) 28mm Conveen Optima Standard (8.5cm) 30mm Conveen Optima Standard (8.5cm) 35mm Conveen Optima Standard (8.5cm) 40mm Conveen Optima Short (5.5cm) 21mm Conveen Optima Short (5.5cm) 25mm Conveen Optima Short (5.5cm) 30mm Conveen Optima Short (5.5cm) 35mm

Drainage Bags
A maximum of 1 leg bag and 1 overnight bag will be sent
Non-sterile Leg Bags: for use with urisheathsConveen Security+ Leg Bag (30cm/500ml) Conveen Security+ Leg Bag (50cm/500ml) Conveen Security+ Leg Bag (30cm/750ml) Conveen Security+ Leg Bag (50cm/750ml) Simpla Profile Leg Bag (50cm/500ml)	Sterile Leg Bags: for use with indwelling cathetersConveen Security+ Leg Bag (30cm/500ml) Conveen Security+ Leg Bag (50cm/500ml) Conveen Security+ Leg Bag (30cm/750ml) Conveen Security+ Leg Bag (50cm/750ml) Simpla Profile Leg Bag (6cm/500ml) Simpla Profile Leg Bag (25cm/500ml) Simpla Profile Leg Bag (6cm/750ml) Simpla Profile Leg Bag (25cm/750ml)
Non-sterile Overnight Bags: for use with urisheathsConveen Leg Bag (30cm/500ml) Conveen Leg Bag (50cm/500ml) Simpla Night Bag (100cm/2000ml)	Sterile Overnight Bags: for use with indwelling cathetersConveen Leg Bag (30cm/500ml) Conveen Leg Bag (50cm/500ml) Simpla Night Bag (120cm/2000ml)

Peristeen Anal Plugs
A maximum of 1 anal plug will be sent
Small Large

Patient details
*First name	*Last Name
*Address	*Suburb/City
*State	*Postcode
Email address	*Phone number
Is the condition short term or long term?*Short term (up to 6 months) Long term (longer than 6 months)	Does the patient receive funding?*NDIS Full funding Partial funding No funding Don't know
Please select the condition this patient requires continence products for:Spinal Cord Injury Multiple Sclerosis Spina Bifida Other Urinary Issues Other Bowel Issues	Additional Information/Requests
	*Note, our continence department no longer offers Releen samples. Sample orders will now be made through our urology team. Click here to request a Releen sample.

Clinician details
*First name	*Last name
*Organisation	If other, please specify:	Address
Suburb/City	State	Postcode

*Send kit toPatient's Home Facility	Coloplast Care Direct A better way to order your Coloplast continence products
Please invite this patient to join the Coloplast Care program for intermittent catheter usersYes	My patient is interested in finding out more about Coloplast Care DirectYes
Support Services declaration of consent By providing your personal and sensitive data, you are consenting to Coloplast that we may process and store your data for the purposes to provide tailored nursing services and healthcare guidance on a regular basis; to fulfill your request and to keep you informed about it in person or by phone, text, email, or post. We will also process your data to improve our products and services and may refer you to healthcare professionals if needed. We may share your data with our sub-vendors when necessary to fulfill the request and transfer data securely outside Australia to support our business operations. You may withdraw consent at any time without ramifications by writing to privacyrequests@coloplast.com or calling us at 1800 653 317. For more information, please visit our privacy policy for consent.
		contactUsBysendUsEmail

Headline

Continence Sample Kit - samples to be sent to the patient

Intermittent Catheters

Urisheaths/Uridomes

Drainage Bags

Peristeen Anal Plugs

Patient details

Clinician details

Coloplast Care Direct

Thank you for your order