Request your free samples!

Interested in Coloplast products? Please submit the following information to request your free product samples

I would like information regarding:




*Privacy Statement

Coloplast respects the privacy of your personal information and will protect the confidentiality of the information contained on this form. The only time the information may be used or shared is if it is (1) required by law; or (2) to provide you with information about Coloplast products, services and wellness education. You may be contacted by Coloplast, its agents, affiliates, contractors, or supply or service providers by telephone, email, US Mail, or other means of communication only for the purpose stated above. If you choose not to receive communication from Coloplast, please contact us at 1-888-726-7872 or email samples@coloplast.com  to request that communication be discontinued.

View desktop version