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FREEPHONE: 0800 012 6779 9.00am – 5.00pm, Monday to Friday
www.clinidirect.co.uk
Ready and waiting 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:
Forename: Surname:
Date of Birth:
Address:
Postcode:
Home Tel No: Mobile:
Email:
Healthcare Professional Name:
HCP Tel No:
Hospital:
GP Name – Dr
GP Address:
GP Postcode: GP Tel No:
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.
Friendly Customer Care Service
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
• Urology patients will also receive a FREE night stand
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. We’re here 9.00am – 5.00pm, Monday to Friday to take your orders and answer any questions you may have.
Taking great care in supplying your regular medical appliances
That’s it! We will then deliver your products on
time and discreetly, within 48 working hours*!
ORDERS CAN BE PLACED SIMPLY:
1 By Post
Post your prescription using a Clinidirect FREEPOST envelope.
2 By Phone (Call us on our FREEPHONE number: 0800 012 6779.
3 By Email
Contact: [email protected]
4 By Collection Service
We can even collect your repeat prescription from your GP.
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.
Whichever product you use, our friendly team will take great care in managing your order and individual needs, one delivery at a time.
* Orders must be placed before 3pm.
Remove and keep me safe!
Cut hole to shape and size of your stoma
Caring for your needs,
one delivery at a time!
Caring for your needs,
one delivery at a time!
Clinidirect Home Delivery Service
Keep this safe PRESCRIPTION RECORD
Please list your prescription items and show your GP, who will be able to provide a repeat prescription for your medical appliances.
Clinidirect Home
Delivery Service
Caring for your
needs, one delivery
at a time!
FREEPHONE: 0800 012 6779
9.00am – 5.00pm, Monday to Friday
www.clinidirect.co.uk
Product Product Code Quantity
Specialist Nurse:
Telephone:
FREEPHONE: 0800 012 6779 9.00am – 5.00pm, Monday to Friday
www.clinidirect.co.ukFREEPHONE: 0800 012 6779 9.00am – 5.00pm,
Monday to Friday www.clinidirect.co.ukClinidirect is a trademark of CliniSupplies Ltd. CS048_0612
FREEPHONE: 0800 012 6779 9.00am – 5.00pm, Monday to Friday
www.clinisupplies.co.uk
20 30 40 50 60 70 mm
¾"
1 1/8"
1 5/8"
2"
2 3/8"
2 ¾"
Patient’s Right Top Patient’s Left
This side away from skin
Stoma Cutting Guide
CliniDirect Home Delivery Service
DC Stoma guide.indd 3 19/06/2012 12:05