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*First Name/ Prénom :

*Last Name/ Nom :

*Email address/ Adresse de courriel :

*Address/ Adresse :

*City/ Ville :

*Postal Code/ Code postal :

*Province/ Province :

*Phone Number/ Numéro de téléphone :

Do you or someone you know have an ostomy? Est-ce que vous ou une personne que vous connaissez avez une stomie?Yes/ OuiNo/ Non

Support Services declaration of consentBy 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 privacyrequests@coloplast.com or calling us at 1(866)293-6349. For more information, please visit our privacy policy for consent.

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At Coloplast, we’re motivated to fight for better care around the world, and we strive to ensure that the people who use our products, can access products and services to help them manage their conditions.

Order your Ostomy Awareness Day sticker and let’s raise awareness together!

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