JavaScript seems to be disabled in your browser. For the best experience on our site, be sure to turn on Javascript in your browser.

Home
Samples

Samples for StomaBags

Samples

Note: We sell anywhere. We send free samples with free shipping only to the US and Canada. For all other countries, samples are free, but there might be a charge for shipping.

Please write the following information:

Brand *

Are you an out-of-pocket buyer? *
Yes    No

Date of Surgery: *

This field is required

Date of Birth: *

This field is required

Language: *
English Spanish
Other:
Type of ostomy *
(to determine the correct product)
Ileostomy Colostomy Urostomy
Requesting Product #:

What product are you currently using?:

Additional comments:
Note: If necessary, the Hollister Service Team may contact you directly regarding this product sample request.

Year and/or Date of Surgery *
This field is required

Type of Stoma*
Flush Recessed Protruding
Pouch Preference:*
1 Piece 2 Piece

Select:*
Drainable Closed End
Pouch Closure:*
Clamp Closure Microseal Closure Velcro Closure

Pouch Color Preference:*
Opaque Transparent
Sample Request
Either enter Coloplast product numbers:

Or check product options below

Is your stoma above the skin level? *
Yes   No

Do you wear a belt? *
Yes   No

Primary Insurance Provider: *

This field is required

Preferred Supplier (optional):

Secondary Insurance Provider: *

This field is required

Stoma size *
(please tell us the approximate diameter)
This field is required
Shape of Stoma *
Oval Round
Problems *
Irritation Adherence Other

Please Explain
Pouch Filter Preference:*
With Filter Without Filter
Barrier Type:*
Flat Convex Deep Convex
Barrier Preference:*
Cut To Fit Precut

Do you have any skin folds, creases, or dips around the stoma? *
Yes   No

Brand Preference
SenSura® Mio
SenSura®
Assura®
Convexity
Flat
Soft Convex
Convex Ligh
Deep Convex
System
One-Piece
Two-Piece Flez
Two-Piece Click
Cut Style
Cut-to-fit
Pre-cut
Pouch Closure
Closed
Drainable
Urostomy
Barrier Type
Extended Wear
Standar Wear
Filter
Yes
No
Accessories
Belt XL Belt
Elastic Barrier Strip
Y-shape
Curved
Straigh
Lubricating Deodorant
Protective Seal
Paste
Strip Paste
Powder
Prep
Name *

This field is required

Email *

This field is required
Please use a well format email.

Mailing address *
(where you would like the sample to be shipped)
Address 1 *

This field is required

Address 2

Phone number 1 *
(where you can be reached with any questions)

This field is required
Phone number 2

Best Time to Call if Necessary *

This field is required

Message

City *

This field is required

State *

This field is required

Country *

This field is required

Zip Code*

This field is required

Please verify your identity by clicking the checkbox below:
This field is required

Why put this?
This Captcha is used to avoid spam. It ensures that you are not a machine.

SEND
Sending email...

100% SECURE PAYMENT
SAFEGUARDING PERSONAL INFORMATION

Original Products

WE ACCEPT

Sign-Up Offer
Get 5% OFF first order*

*Conditions Apply

Brand *
Are you an out-of-pocket buyer? * Yes No
Date of Surgery: * This field is required Date of Birth: * This field is required Language: * English Spanish Other: Type of ostomy * (to determine the correct product) Ileostomy Colostomy Urostomy Requesting Product #: What product are you currently using?: Additional comments: Note: If necessary, the Hollister Service Team may contact you directly regarding this product sample request. Year and/or Date of Surgery * This field is required Type of Stoma* Flush Recessed Protruding Pouch Preference:* 1 Piece 2 Piece Select:* Drainable Closed End Pouch Closure:* Clamp Closure Microseal Closure Velcro Closure Pouch Color Preference:* Opaque Transparent Sample Request Either enter Coloplast product numbers: Or check product options below Is your stoma above the skin level? * Yes No Do you wear a belt? * Yes No	Primary Insurance Provider: * This field is required Preferred Supplier (optional): Secondary Insurance Provider: * This field is required Stoma size * (please tell us the approximate diameter) This field is required Shape of Stoma * Oval Round Problems * Irritation Adherence Other Please Explain Pouch Filter Preference:* With Filter Without Filter Barrier Type:* Flat Convex Deep Convex Barrier Preference:* Cut To Fit Precut Do you have any skin folds, creases, or dips around the stoma? * Yes No
Brand Preference SenSura® Mio SenSura® Assura® Convexity Flat Soft Convex Convex Ligh Deep Convex System One-Piece Two-Piece Flez Two-Piece Click Cut Style Cut-to-fit Pre-cut	Pouch Closure Closed Drainable Urostomy Barrier Type Extended Wear Standar Wear Filter Yes No Accessories Belt XL Belt Elastic Barrier Strip Y-shape Curved Straigh Lubricating Deodorant Protective Seal Paste Strip Paste Powder Prep
Name * This field is required	Email * This field is required Please use a well format email.
Mailing address * (where you would like the sample to be shipped) Address 1 * This field is required Address 2 Phone number 1 * (where you can be reached with any questions) This field is required Phone number 2 Best Time to Call if Necessary * This field is required Message	City * This field is required State * This field is required Country * This field is required Zip Code* This field is required Please verify your identity by clicking the checkbox below: This field is required Why put this? This Captcha is used to avoid spam. It ensures that you are not a machine. SEND Sending email...

Samples for StomaBags

Samples

PRODUCT DOT MATCHING