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      Healthcare Professionals

      Order your Male External Catheter samples

      Please accurately fill out the form below. If you have questions about Coloplast catheters, please contact us by phone at

      1-855-605-7588 or by email at samples@coloplast.com

      Please provide the following information for the individual with an ostomy requesting this product:
      Is this a cell phone or a land line? *

      I currently use the following product(s):



      Proper sizing is important. Please use our sizing guide and application techniques to select the right size for you
      Please select the size(s) you would like to sample:








      Coloplast Confirmation of Consent



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