Me+ Register your patient- Convatec

More than just great products, the Convatec me+™ program brings the tools and advice to help ostomates get back to doing all the things that make them unique.

The me+™ Support Team

Our expert team of nurses and product specialists is available to:

Help your patient figure out which products are right for them.
Teach your patient how to take care of the skin around their stoma and change their ostomy system.
Help your patient cope with tricky lifestyle issues and anything else that may come up.
And more.

me+™ Discharge Program for New Ostomates

In addition, the me+™ discharge program connects new ostomates with our experienced team of nurses and includes additional product samples for the first few weeks after discharge. Plus, we offer an exclusive one-year complimentary subscription to the third-party Telus® Health assistance program – All to help make the new ostomate’s recovery as smooth as possible so they can feel stronger, more confident, and ready for what's ahead.

More than just great products, the Convatec me+™ program brings the tools and advice to help ostomates get back to doing all the things that make them unique.

The me+™ Support Team

Our expert team of nurses and product specialists is available to:

Help your patient figure out which products are right for them.
Teach your patient how to take care of the skin around their stoma and change their ostomy system.
Help your patient cope with tricky lifestyle issues and anything else that may come up.
And more.

me+™ Discharge Program for New Ostomates

In addition, the me+™ discharge program connects new ostomates with our experienced team of nurses and includes additional product samples for the first few weeks after discharge. Plus, we offer an exclusive one-year complimentary subscription to the third-party Telus® Health assistance program – All to help make the new ostomate’s recovery as smooth as possible so they can feel stronger, more confident, and ready for what's ahead.

Complete the form below to enroll your patient in me+™

*Required

Patient Information

First Name*

Last Name*

Address Line 1*

Address Line 2

City*

Selection

Postal Code*

Country

Email Address*

Telephone Number (Do not include spaces)*

Selection

i.e., Product code numbers currently using, additional stoma skin characteristics, etc.

Healthcare Professional Information

Your First Name*

Your Last Name*

Your Email Address*

Your Telephone Number*

Facility Name*

City*

Selection

Patient Consent Acknowledgement

By completing this form on behalf of you and your patient, you acknowledge the following:

You and your patient’s privacy is important to us. Convatec will not share your patient’s or your personally identifiable information with an unrelated party without your and your patient’s permission. Please read our privacy policy where you can find detailed information on how we protect and use customer information; we can also provide you and you patient with a copy on request.

Patient Consent Acknowledgement

By completing this form on behalf of you and your patient, you acknowledge the following:

You and your patient’s privacy is important to us. Convatec will not share your patient’s or your personally identifiable information with an unrelated party without your and your patient’s permission. Please read our privacy policy where you can find detailed information on how we protect and use customer information; we can also provide you and you patient with a copy on request.

Multiple or single choice

*You and your patient authorize Convatec to enroll them in the me+ program. The patient understands that the personal information submitted here will be used for the purposes of their membership. The use of your and your patient’s information may include contact by phone, email, text or mail from Convatec and its affiliates for coordination of products and services related to this program

Multiple or single choice

*Your patient authorizes Convatec to identify and refer them to a designated Convatec retailer if they decide to order Convatec products. The patient also authorizes Convatec to disclose to their healthcare provider or to the providing manufacturer (1) their participation in the program (2) the samples or products ordered, and (3) any feedback provided regarding the program or such products and samples.

Multiple or single choice

Your patient authorizes Convatec and its affiliates to contact them through commercial electronic messages (emails, text), traditional mail or phone calls for the purpose of communicating promotional information (marketing messages) about Convatec products, services, news, and events.

You and your patient can withdraw these authorizations at any time by contacting us by telephone at 1-800-465-6302, or by email at convatec.canada@convatec.com. The patient may also click on the ‘Unsubscribe’ link in the footer of the emails or text messages they may receive.

Enroll Your Ostomy Patients in the me+™ Support Program

Complete the form below to enroll your patient in me+™

Complete the form below to enroll your patient in me+™

Patient Information

Healthcare Professional Information