me+ Patient Enrollment

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 LifeWorks^® patient 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.

*Required

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

Patient Information

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First Name *

Last Name *

Email Address *

Phone Number (Please do not include spaces) *

Country *

Surgery Type *

Surgery Date *

Stoma Characteristics *

Product Used *

List of Recommended Convatec Products/Additional Information

Healthcare Professional Information

Your First Name *

Your Last Name *

Your Email Address *

Your Phone Number *

Facility Name *

City *

Province *

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.

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 *

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. *

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 Patients in me+™ from Convatec Give your ostomy patients an invaluable layer of support and care to help them through their recovery after ostomy surgery

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

Patient Information

Healthcare Professional Information