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D-Ostomy Subscription
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Sample Request
Due to high demand, samples of orange drainable pouches will not be available until the first week of October. Until then, we will offer closed orange pouches for free samples.
Are you a patient or a clinician?
I'm a patient
I'm a clinician
I'm both
Do you prefer a closed or drainable pouching system?
Closed
Drainable
Anything else you would like to tell us about your thoughts or experiences with D-Ostomy?
Would you prefer supplies for a right or left sided ostomy?
Right
Left
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What is your email address?
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What is your phone number?
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Where should we send your samples?
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Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
How did you hear about us?
(Required)
My doctor
My ostomy nurse
My hospital, wound care clinic, or home health care agency
Friends and family
Social media posts
Stumbled across your website or page on a distributor site
Other
By requesting these samples, you acknowledge and agree that Versipel, LLC may collect and share your personal contact information (including name, email, phone number and/or shipping address) with our partners, vendors, distributors, and affiliates (“Partners”). You agree to allow Partners to contact you regarding the requested sample, product information, or related healthcare offerings. This sharing is intended to facilitate sample delivery, provide technical support, and offer relevant product information. Your submission of this request for samples constitutes your express consent to this disclosure. You acknowledge that you have read and understand this Authorization and Waiver, have had the opportunity to ask questions, and agree to the terms set forth above. You further acknowledge that your contact information may be shared with multiple Partners and that individual Partner privacy practices may vary.
(Required)
Yes
No
Would you like to subscribe for updates, request free samples, or do both?
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Home
About
Our Team
FAQs
Clinicians
Blog
Samples
Contact
Home
About
Our Team
FAQs
Clinicians
Blog
Samples
Contact
Location
201 South Blakely St. #324
Dunmore PA 18512
Call Now:
1-877-836-7866
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