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Comfizz Stoma Wear
Prescription Request Form - UK Only

Let us organise your prescription for you!
Just fill out this simple online form below, click submit,
then sit back and wait for your order to arrive.

New Customers Please try just a couple of garments to check fit and suitability
before requesting more on prescription.

Existing Customers If you have already tried Comfizz and you know what you want theres not need to place a small order. Just go ahead and request what you need. Most GP's are happy to prescribe 6 garments a year.

CONTACT DETAILS

Title: Date:
First name: Surname:
Address:
Postcode:
Tel No:
  Please enter your email address to enable us to confirm that we have received your prescription request.
Email:
Are you a new or an existing customer? New Customer
  Existing

PRODUCT DESCRIPTION

Product Name: Colour: Size: Quantity:
1.
2.
3.
4.
5.
Your Current Stoma Delivery Company:
Leave blank if you don't use one or have
no preference who delivers your goods
Doctor's Name:
Surgery Name:
Address:
Tel No:
Please enter the code as shown below:
PRODUCT DESCRIPTION
Please refer to the specific product pages when completing this form to ensure you have the correct colour and size information.

Your goods will be delivered normally within 1-2 weeks dependant on your GPs response.

Learn how Comfizz innovative
product range helps people
just like you every single day...
" Thank you for your prompt attention. Congratulations on finding a product that ALL ostomists have been searching for. Unbeleivably comfortable to wear and provide much needed support for a hernia ... but best of all I am no longer conscious of the 'bump' "
Herts
" I have only had a stoma for 3 months so none of my cloths fit as they did. When I wear Comfizz shorts the high waistband keeps my pouch in place and provides extra comfort & support. "
Hull
" I would like to let you know how comfortable your Comifizz waistband is. I wear it all the time which I could not do with other garments I have tried. I wish I had your waistband from the beginning as I am sure I would not have got a hernia."
Malton
[View written testimonials]