Sign up for the Care programme

Please provide the following information:

Please do not contact me by:

Privacy Statement

By providing your personal information on this form, you are consenting to Coloplast using it for administration and analysis purposes. We will share this information with healthcare professionals and other companies needed to deliver your products or if required by law. We assure you, your personal information won't be passed on to any 3rd parties for marketing purposes however we may wish to contact you for customer satisfaction and research purposes. 
From time to time we do let our customers know of new products or services which may be of interest by phone, email or post. By submitting your information to us, you consent to us contacting you in this way unless you have indicated that you would prefer for us not to contact you by ticking the box above.


Sample request

Thank you

Your sample request has been received successfully

View desktop version