Thanks for submitting your sample request for the  SpeediCath® Compact catheter

Intermittent catheters are a prescription product. In order to send you a samles, we need to confirm the details of your catheter persprition.

To get your samples faster, please provide your birth date and supplier and/or clinic information so that we can confirm your prescription on your behalf.

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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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