Select country
Close
32
Country websites
Find your Coloplast website
About Coloplast Country
Coloplast UK
Coloplast Charter
Work for us
News
Latest news
Contact
Customer Care
Corporate Information
Mission & Values
History
Corporate Responsibility
People & Organisation
Global presence
Visit Coloplast.com
Find your Coloplast country website
Select your country
Select your country
Headline
North America
South America
Europe
Africa
Russia
Asia
Australia
Menu
Search
About us
Select country
▾
Search
Stoma
Bladder & Bowel
Wound
Urology
Products and Samples
About us
Coloplast Charter
Download our guide to understanding UTIs
First name*
Last name*
Address*
City*
Postcode*
Phone number*
Email address*
Reason for using self-catheters
Cancer - bladder
Cancer - colorectal
Cancer - other
Cauda Equina syndrome
Endometriosis
MS
Spina Bifida
Overactive bladder
Pelvic floor muscle dysfunction
Spinal cord injury (complete)
Spinal cord injury (incomplete)
Traumatic brain injury
Unknown
Other
- please select -
How much do UTIs impact on your day-to-day life?
I worry about UTIs all the time
I sometimes worry about UTIs
I rarely worry about UTIs
I never worry about UTIs
- please select -
Which catheter are you currently using as your primary method of bladder emptying?
SpeediCath
Hollister Vapro
Infyna Chic
Lofric Sense
Lofric Elle
B-Braun Actreen
Clinimed
Curan Lady
Hydrosil Go
Catheter with integrated bag
Other
- please select -
I have had my continence needs assessed by a Healthcare Professional and prescribed to use intermittent self catheters*
Yes
No
By checking this box you are consenting to us processing your details and contacting you as part of this request, please see our
Declaration of Consent
.
Would you like to stay informed?
By providing your personal and sensitive personal data on this form, you are consenting to Coloplast and Coloplast Charter using it for administration and analysis purposes and to process your order. We may share this information with healthcare professionals and other companies required for the delivery of your products or as required by law. We may also contact you to ask you to clarify your requirements and to ask you to complete customer satisfaction or other surveys, and may use 3rd parties to handle this as outlined in our Privacy Policy which can be found at Coloplast.co.uk/privacy. We often keep customers up to date with the latest information on the products and services we offer. Please indicate if you would not like to be kept informed by:
Email
SMS
Phone
Post
contactUsBy
sendUsEmail
Close
Sample request
Thank you
Your sample request has been received successfully
View desktop version