Request A Sample

Sample Request Form

Complete this brief form to request your free sample.

Have questions? Call our me+™ support team at 1-800-422-8811 today.

Step 1 of 2

First Name*

Last Name*

Email Address*

Phone Number*

You authorize ConvaTec and its affiliates to call, email, text or mail you information about ConvaTec's products and services. If you would like to order ConvaTec's products, you authorize ConvaTec to identify and transfer you to a designated ConvaTec retailer and that ConvaTec may disclose to your healthcare provider or to the providing manufacturer (1) your participation in the me+™ program, (2) the samples or products ordered, and (3) any feedback provided regarding the program or such products and samples. You may withdraw this authorization by calling or writing to us.

Your privacy is important to us. By submitting your information, you agree to ConvaTec's privacy policy, available by clicking here.

Step 1 of 2

Step 2 of 2

Back

Step 2 of 2