Request Ostomy Accessories- Convatec

Complete this form to request free samples of Convatec Ostomy Accessories

Have questions in the meantime? Call our Convatec me+ support team at 1-800-465-6302, Mon-Fri, 8am-6pm (ET) to speak with a nurse or product specialist. You may also email us directly at convatec.canada@convatec.com

*Required

Complete this form to request free samples of Convatec Ostomy Accessories

Have questions in the meantime? Call our Convatec me+ support team at 1-800-465-6302, Mon-Fri, 8am-6pm (ET) to speak with a nurse or product specialist. You may also email us directly at convatec.canada@convatec.com

*Required

First Name*

Last Name*

Address Line 1*

Address Line 2

City*

Province*

Postal Code*

Country

Telephone (Do not include spaces)*

Email Address*

What is the size (diameter) of the hole you have cut for your stoma?*

Stoma Type*

Is your stoma in a dip, crease or fold?*

Do you have skin issues around your stoma?*

If yes, please provide details

Which brand are you currently using?*

Which Ostomy Accessories are you interested in?*

eakin Cohesive® Seal Small

eakin Cohesive® Seal Large

eakin Cohesive® SLIMS™

eakin Cohesive® Skin Barrier 10x10 cm (4x4 in)

eakin Cohesive® Skin Barrier 10x20 cm (4x8 in)

eakin Cohesive® StomaWrap™

ESENTA® Adhesive Remover Wipes

ESENTA® Diamonds®

ESENTA® Skin Barrier Wipes

Stomahesive® Skin Barrier 10x10 cm (4x4 in)

Stomahesive® Skin Barrier 20x20 cm (8x8 in)

Stomahesive® Strips

NEW! eakin freeseal® air (Starter hole 18mm)

NEW! eakin freeseal® air (Starter hole 30mm)

NEW! eakin freeseal® versa (Starter hole 18mm)

NEW! eakin freeseal® versa (Starter hole 30mm)

Notes

How We Use Information

Treating your personal data with care is important to us. Please read our privacy policy where you can find detailed information on how we protect and use personal data.

How We Use Information

Treating your personal data with care is important to us. Please read our privacy policy where you can find detailed information on how we protect and use personal data.

Privacy Policy*

* I agree to the processing of my personal data (name, surname, email address) by Convatec for the purpose of completing my product sample request. I know that providing data is voluntary, but necessary for the Customer Relations Center product specialist or nurse to assess which product(s) best meet(s) my specific requirements.

Marketing Consent

From time to time, we (Convatec) would like to send you commercial electronic messages (emails) for the purpose of communicating promotional information (marketing messages) about Convatec products, services, news, and events. By ticking the box, you consent to us emailing you for this purpose.

You can opt out of receiving marketing messages anytime by contacting us by telephone at 1-800-465-6302, or by email at convatec.canada@convatec.com. You may also click on the ‘Unsubscribe’ link in the footer of the emails you will receive.

Please note our calls come from number 1-800-465-6302 or as potential spam.

You can opt out of receiving marketing messages anytime by contacting us by telephone at 1-800-465-6302, or by email at convatec.canada@convatec.com. You may also click on the ‘Unsubscribe’ link in the footer of the emails you will receive.

Please note our calls come from number 1-800-465-6302 or as potential spam.

Convatec Product Samples