Taking great care in supplying your regular medical appliances

Here at Clinidirect, we strive to delight our customers through our healthcare home delivery service that offers a caring, dependable and timely response to your needs.

Ready and waiting Friendly Customer Care Service

To register for the Clinidirect home delivery service for your medical appliances, simply complete this form and send it to us with your prescription, using a Clinidirect FREEPOST envelope.

Title:

Whichever product you use, our friendly team will take great care in managing your order and individual needs, one delivery at a time.

Our team of trained staff are here to help take care of all your needs. We aim to provide a personalised, discreet and polite service. Were here 9.00am 5.00pm, Monday to Friday to take your orders and answer any questions you may have.

Forename: Date of Birth: Address:

Surname:

Caring for our customers with:

A repeat dispensing service Dispensing all brands of stoma, woundcare and urology appliances Repeat prescription collection service  Stoma appliance customisation Complimentary wipes and disposal bags with every order
Home Tel No: Email: Healthcare Professional Name: HCP Tel No: Hospital: GP Name Dr GP Address:

Postcode: Mobile:

ORDERS CAN BE PLACED SIMPLY:

By Post

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By Email

Post your prescription using a Clinidirect FREEPOST envelope.

Contact: info@clinidirect.co.uk By Collection Service

Urology patients will also receive a FREE night stand

GP Postcode:

GP Tel No:

By Phone

Call us on our FREEPHONE number: 0800 012 6779.

We can even collect your repeat prescription from your GP.

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We will use the information you provide to dispense your prescription, which includes sharing it with our appointed courier service and in some instances sharing it with your healthcare professional. We will respect the privacy of your personal data and will comply with all relevant and current data protection legislation. We will not disclose your personal data to any other third party. If you wish to update or delete your personal information please write to us at: CliniSupplies Ltd, Qualitas House, 100 Elmgrove Road, Harrow, Middlesex, HA1 2RW.

Orders must be placed before 3pm.

FREEPHONE: 0800

www.clinidirect.co.uk

012 6779

9.00am 5.00pm, Monday to Friday

CliniDirect Home Delivery Service

Stoma Cutting Guide

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Clinidirect Home Delivery Service

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PRESCRIPTION RECORD Please list your prescription items and show your GP, who will be able to provide a repeat prescription for your medical appliances.

Product

Product Code

Quantity

20 30 40 50 60 70 mm " 1 1/8" 1 5/8" 2" 2 3/8" 2 " This side away from skin

0800 012 6779

9.00am 5.00pm, Monday to Friday
19/06/2012 12:05

FREEPHONE:

DC Stoma guide.indd 3

www.clinidirect.co.uk

0800 012 6779

9.00am 5.00pm, Monday to Friday

FREEPHONE:

Cut hole to shape and size of your stoma

Clinidirect Home Delivery Service

Specialist Nurse: Telephone:

www.clinisupplies.co.uk

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Clinidirect is a trademark of CliniSupplies Ltd. CS048_0612

FREEPHONE: 0800

www.clinidirect.co.uk

012 6779

9.00am 5.00pm, Monday to Friday

FREEPHONE: 0800

www.clinidirect.co.uk

012 6779

9.00am 5.00pm, Monday to Friday