About you

Welcome to Coloplast Care and your Ostomy Check

Simply fill out the form below to take the Ostomy Check. We will then help you out with hints, tips and lifestyle advice on living with your stoma.

Title

Name

Email

Postcode

What is your date of birth (DD/MM/YYYY)?

Have you had surgery yet?

When is your surgery planned?

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 below. Please do not contact me by:


I accept that Coloplast will use my personal information in this way.
I grant Coloplast permission to contact me by email. Coloplast Care is an email based programme
Coloplast UK Ltd. - Nene Hall, Peterborough Business Park, Peterborough PE2 6FX - T:0800 783 1434 - E:gbccare@coloplast.com
Cookie policy - Legal aspects