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Please fill in personal details about your surgery date, your type of ostomy and your address.
This information helps us provide the best possible support to meet your needs.

Surgery date

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Note: If you do not recall or know your exact surgery date, choose a date as close to what you recall or expect.

Describe your stoma

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Note: It's only possible to select one stoma type, if you have two stoma's, please select one of the stoma types you have.

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