Access to Healthcare Survey 


Please rate how often you are impacted by the statements below.
How often do you feel you have adequate access to all the products you need for your healthcare condition?

How often do you think your insurance limits your access to the healthcare products you need?

How often do you think your insurance limits your access to urinary catheters?

If you use bowel management products, how often do you feel you have adequate access to the products you need?

Please answer each of the following questions.
Are you reusing catheters because your insurance doesn't allow you a new catheter for each time you catheterize?

Are you currently using, or have you previously used, a hydrophilic coated catheter (a catheter that has water in its packaging or that you need to add water to?

If you have used a hydrophilic-coated catheter, has your supplier ever suggested that you switch to a non-hydrophilic catheter (no water in the package) that you have to prepare with a gel or lubrication product?

If your supplier has suggested that you switch to a non-hydrophilic catheter, did you follow that suggestion?

May we contact you regarding your supplier's suggestion to switch to a different catheter?

Do you feel you have adequate information about new urinary catheter options?

Has a health care professional ever offered you new urinary catheter options to try?

Are you aware of the requirements necessary to order catheters in a different billing code than what you're currently using (i.e. catheter with attached bag vs. straight tip intermittent catheter)?

Are you aware you can try new products for free by contacting a urinary catheter manufacturer?

How do you learn about new urinary catheters? (Select all that apply)

Which of the following bladder management products do you use?

On average, how long have you been using the bladder management product(s) you selected above?

Which of the following bowel management treatments do you use?

On average, how long have you been using the bowel management treatment(s) you selected above?

What best describes your medical condition?

What is your primary type of insurance?

Which of the following products do you feel are most difficult to be covered by your insurance? (Select the 3 most difficult)

When it comes to urinary catheter features, which are most important to you? (Select all that apply)

Coloplast would like to keep you informed about products and services that could help make your life easier. Please provide your contact information if you are interested.

*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  to request that communication be discontinued.


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