Hollister Secure Start Services: Clinician-Assisted Enrollment | Continence Care

Secure Start^SM Services:
Clinician-Assisted Enrolment

Personalised Patient Support

The Secure Start^SM service is a telephone service that provides patients with the support and advice if you are performing Intermittent Self Catheterisation.

Your Secure Start advisor will:

Phone you for the first 2 days after your initial self-catheterisation
Be available to answer any routine enquiries on our Freephone telephone number 0800 376 1310 Monday to Friday from 8.30am to 5.00pm

Please support the patient to complete the form below. If you have any questions please call us on 0800 376 1310.

Required fields are indicated by asterisk *

Title:

First Name:

Last Name:

Street Address:

Additional Address Details:

City:

Post Code:

Patient's Email Address:

Phone Number:

Birthdate

Delivery Service:

Reason for CISD:

Duration of Need:

Date of Clinic

Number of Catheters Needed per Day:

Catheter Size:

Manufacturer of Current Catheter:

Name of Current Catheter:

Product Number/SKU of Current Catheter:

UTI History:

Yes

Latex Allergy:

Yes

CeraPlus™ Pouch Upgrade

VaPro™ Intermittent Catheters

AnchorFast SlimFit™

Sustainability

Your Basket

Secure Start^SM Services:
Clinician-Assisted Enrolment

Personalised Patient Support

Secure StartSM Services:Clinician-Assisted Enrolment

Personalised Patient Support

Secure Start^SM Services:
Clinician-Assisted Enrolment