Join Coloplast^® Care – fill in your information below

Coloplast welcomes you to join Coloplast Care. Simply fill out the form below to sign up and start your Coloplast Care program with tailor-made support and advice. You will receive your first email today.

1. Your information
2. Your ostomy
3. Your life

Why we need your personal information

Every person with an ostomy is unique; the more you tell us about yourself and your situation, the better we can help you. With every detail you provide, the advice you receive will become more relevant

More info = more support

Your phone number enables us to give you personal advice over the phone – and by giving your address, you can get free samples and accessories.

Title

First name*

Last name*

Date of birth*

Gender *

Address *

City *

Province *

Postal code *

Home Phone*

Mobile Phone*

Email address*

Confirm email address*

Do you know your surgery date?*

Please check the box to ackknowledge that you have read and understood the privacy statement*

I have read and understood the privacy statement

Privacy statement
Coloplast Canada has created this privacy statement in order to demonstrate our firm commitment to privacy.

Coloplast will respect the privacy of your personal information and protect the confidentiality of sensitive information. Information provided to us by you or by a third party, will be used to process your orders and for general administrative record-keeping purposes. The information may also be used or shared with a third party if required by law or in order to provide you with information related to Coloplast's products, services and wellness education. You may be contacted by Coloplast, its agents, group companies, contractors, supply or service providers (“Coloplast Agents") by telephone, email, letter, or other means of communication but only for the purposes referred to above. In such cases Coloplast will ensure that the Coloplast Agent will comply with applicable privacy legislation as well as this Privacy Statement.

By submitting your personal information to us you consent to Coloplast, and any Coloplast Agents, to store and use this information in order to provide information and updates on Coloplast's products and services and to allow Coloplast to contact you by email and/or ordinary mail and/or telephone, including recording of such phone calls – and, if needed, to clarify your sample requirements.

If you no longer wish to receive communication from Coloplast or would like to request that any personal data in Coloplast’s possession be deleted, please contact Coloplast’s local Consumer Support Services by email ca_conspec@coloplast.com with your request that all communication has to be discontinued

Join Coloplast® Care – fill in your information below

Why we need your personal information

More info = more support

Join Coloplast^® Care – fill in your information below