Stoma Image Upload Page

We understand that it is sometimes difficult to explain what you are experiencing over the phone and that sending a photo would be easier.We encourage you to use the form below to submit your photo and one of our experienced Specialists will be in contact to help provide tailored and effective solutions and advice.

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First Name*	Last Name*
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Phone Number*
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.
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Upload stoma photo

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By submitting this form, I give consent to Coloplast to contact me via e-mail and phone to discuss my stoma. I consent that Coloplast may use the image and the information I provide for advice, product solution offering, teaching and medical / professional publications.

The consent can be withdrawn at any time by contacting Coloplast via email or phone. For more information about Coloplast’s processing of personal data please see the privacy notice.

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Stoma Image Upload

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