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Coloplast Charter
SenSura® Mio Convex. Proven security for inward fit.
Request your free SenSura Mio Convex sample
An ostomy baseplate designed for inward areas and clinically proven to reduce leakage.
First name*
Last name*
Address*
City*
Postcode*
Phone number*
Email address*
What type of convexity do you require?
Flat (For stomas that protrude evenly from the skin)
Soft (For stomas with an opening above skin level that need gentle support)
Light (For stomas with an opening level with the skin that need moderate help to protrude)
Deep (For stomas with an opening below skin level that need a lot of help to protrude)
What kind of pouch would you like?*
1-piece
2-piece
What type of stoma do you have?*
Colostomy
Ileostomy
Urostomy
Do you have skin ulcers?
Yes
No
Do you have a hernia?
Yes
No
Which type of product would you like to sample?
SenSura® Mio Convex 1-Piece Closed
SenSura® Mio Convex 1-Piece Drainable
SenSura® Mio Convex 1-Piece Urostomy
SenSura® Mio Convex 2-Piece Click
SenSura® Mio Convex 2-Piece Flex
What is your stoma size? (e.g. 25mm)
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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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
Phone
Post
SMS/Text
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Sample request
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