Order your SpeediCath® samples

SpeediCath Compact Set

For catheter users - please fill out the form below.

If you are a Healthcare Professional, please order your samples on our HCP order form

Is this a cell phone or a land line? *

To get your samples faster, please provide your birthdate and supplier and/or clinic information so that we can confirm your prescription on your behalf.
Please help confirm my catheter prescription

Coloplast Confirmation of Consent


*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 unsubscribe-us@coloplast.com  to request that communication be discontinued.


If you have questions, or prefer to speak to a Coloplast representative, please call us at 1-855-605-7588


Order your free samples

Thank you for your order

Your order is complete!

View desktop version