Ostomy Type Colostomy
Ileostomy
Urostomy
Other (Specify)
Date of Surgery
If you have not yet had surgery, please indicate in the comments below so we may better assist you.
Stoma Profile Recessed
Flush
Protruding
Prolapsing
Select Stoma Shape (Click here for more detail) Round
Oval
Select Stoma Size (click for detail) Round 1/2"
Round 5/8"
Round 3/4"
Round 7/8"
Round 1"
Round 1-1/8"
Round 1-1/4"
Round 1-3/8"
Round 1-1/2"
Round 1-5/8"
Round 1-3/4"
Round 1-7/8"
Round 2"
Skin Condition Healthy
Healthy yet sensitive
Irritated
Raw and weepy
What literature would you like to receive? Pouches
Belt Guide
Adhesive
Other
You selected (Other). What products would you like to sample and what literature would you like to receive?
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