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Bladder & Bowel
Does your appliance fit your body?
Let us understand your needs by filling out a short questionnaire below. One of our Care Advisors will be in touch with you to discuss your results.
How would you best describe the form of the area around your stoma?
Is the form of the area around your stoma Uniform or Variable?
Is the area around the stoma soft or firm?
Do you have superficial or deep skin irregularities around your stoma? Superficial creases or deep folds?
Where is your stoma located?
Above the bending line
At the bending line
Below the bending line
What’s the position of the stoma opening in relation to the surface of your skin?
Above skin surface
Level with the skin surface
Below skin surface
Describe the output from your stoma
Which type of pouching system do you prefer?
1-piece pouching system
2-piece pouching system
Date of Surgery (*)
Where did you hear about this? (*)
Retailer / Clinician
Support Services declaration of consent
By providing your personal and sensitive data, you are consenting to Coloplast Canada that we may process and store your data for the purposes to provide tailored services and healthcare professional reviewed guidance on a regular basis; to fulfill and inform you of your request by phone, text, email, or mail. We will also process your data to improve our products and services and may refer you to healthcare professionals if needed. Information provided to us by you or a third party will be used to process orders and for general administrative record-keeping purposes. The information may also be used or shared with a third party if required by law to provide you with information related to Coloplast’s products, services and wellness education. We will also let you know about relevant Coloplast products and services via phone, text, email, or mail (marketing). We may share your data with our sub-vendors when necessary to fulfill the request and transfer data securely outside of Canada to support our business operations. You may withdraw consent at any time without ramifications by writing to email@example.com or calling us at 1(866)293-6349. For more information, please visit our
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