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Request a Sample
International Requests

 

To try free samples of our products or request an item of literature complete the form below. Then click the 'Send Request' button at the bottom of this page.

International enquiries and sample requests should be directed to your nearest Dansac Supplier.

These suppliers can be located by using the menu link to the left, the top right of this page or by clicking here www.dansac.com

Please be aware that it may be necessary for us to contact you by phone if the information supplied is incomplete.

Allow up to 10 days for delivery.

 

My Stoma Size is   

My Stoma Type is (if known)

Urostomy

My Stoma is (if known)

Temporary
Permanent

My Current  Product   and/or Code is (if known)

I Currently use Convexity

I'm unsure
I'm unsure, please call me

Pouch Details (please select one of the options from each of the following four sections)

   1. 2. 3. 4.
Pre Cut
Drainable
Two Piece

 

Accessories

Literature

 
   

For us to process your request, all fields marked with an asterisk (*) must be completed.

If you are completing this request on behalf of an ostomate, please provide your details in the comments/further information box at the end of this section.
 
Your Full Name:*
Street Number*:
Street Name*:
Suburb*:
State*:
Post Code:
Area Code:
Telephone*:
Email*:

My Association:
Comments: Please provide any further information that may assist us with your request or enquiry. Remember, the more information you provide, the better we are able to assist you with your request.
 
Sample requests from this site are specific to Australia and New Zealand only.   Please uncheck this box if you do not wish to receive information regarding Dansac products and/or future promotions

 

  
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