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Download a free copy of the Managing a Parastomal Hernia guide Téléchargez un exemplaire gratuit du guide Gestion d’une Hernie Péristomiale.
Please select one / S'il vous plait sélectionner en un:*
I have an ostomy / J’ai une stomie
I am a caregiver of someone with an ostomy / Je prends soin d’une personne stomisée
I am a healthcare professional (HCP) / Je suis un professionnel (PS)
Other
HCPs, please enter facility name / PS, veuillez saisir le nom de l'établissement:
If Other, please explain / Si autre, veuillez expliquer:
First name / Prénom:*
Last name / Nom de famille:*
Address / Addresse:*
City / Ville:
Province*
Postal Code / Code postal:*
Email address:*
Surgery Date / date de la chirurgie:*
Phone number / Numéro de téléphone:*
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