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


Please provide the following information for the catheter user requesting this product: 
Currently using the following products:

By checking the box, I acknowledge:

*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.


Order your free samples

Thank you for your order

Your order is complete!

View desktop version