Healthcare Professionals- order free ostomy samples

Please fill out the following information for the person with an ostomy.
Is this a cell phone or a land line? *


Which Coloplast system are you interested in?

What accessories would you like to try?

Type of barrier

Pouch color

Pouch Closure

Surgery Type


On what product was the individual discharged?

Coloplast Confirmation of Consent



Order your free samples

Thank you for your order

Your order is complete!

View desktop version