HOLLISTER GLOBAL HOME ABOUT US CONTACT US SEARCH

Ostomy Care Products eCatalog Printable Catalog Latex Statement Reimbursement New Technology Product Migration Product Discontinuation Competitive Product Converter Request a Sample Learning Center Secure Start Where to Buy News & Events Virtual Center Clinical Studies/Product Surveys WE'RE LISTENING We receive our best inspiration from people who use our products. As stated in our mission statement by listening to our customers . we will gain a better understanding of the needs which we can best satisfy. If you would like to be considered for inclusion in a survey or product evaluation please complete the following form. First Name* Last Name* Street Address* City* State* - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Armed Forces Africa Armed Forces America Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific Zip Code* Daytime Phone Number* E-mail Address* Where do you purchase your ostomy supplies? Retailer Name City State - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Armed Forces Africa Armed Forces America Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific Zip Code My insurance is: Medicare Medicaid Private Carrier I have a: Colostomy Ileostomy Urostomy My Stoma Size (inches or mm) My stoma is: (Select more than one.) Protruding Retracted Round Flat Irregular Shape What ostomy product do you currently use? Hollister ConvaTec Coloplast Other Barrier Stock Number Pouch Stock Number Which type of barrier do you prefer? (Select more than one.) Precut Cut-To-Fit Flat Convex What type of ostomy accessories are you using? Paste Barrier Rings Pouch Deodorants Other Accessories Stock Number I would like to subscribe to the Secure Start Newsletter. Send me the printed version. (Must provide valid mailing address.) Send me the electronic version. (Must provide valid e-mail address.) Questions/Comments If, after receiving this request, our experts have a better alternative for you, it will be sent promptly. Please contact me, in the future, with new product information and other valuable updates.* Yes No + By submitting information online, you agree that such information will be governed by our Privacy Policy and Copyright/Disclaimer statement. PRIVACY STATEMENT Your privacy is important to Hollister Incorporated ("Hollister"). Hollister will not sell or rent customer information to others. Personal information collected by Hollister is used to contact customers about Hollister and its products and services and is only shared with other outside organizations (service providers) to help them contact customers on behalf of Hollister. If you no longer wish to receive such communications, you may "opt out" at any time by calling Hollister at 1-888-740-8999, Monday through Friday, 8:30 a.m. to 5:30 p.m. CST. I have read and acknowledge the Privacy Statement.* * Indicates required field < back

Print Page Using This Site Site Map Copyright/Disclaimer Privacy Policy