Create your accountStep 1 / 4 WelcomeOrdering your stoma or continence devices couldn’t be easier: start by registering online for our free home delivery service.Complete the form and a member of our friendly team will be in touch to complete your account setup and get you on your way to receiving your first hassle free home delivery.You’re free to choose how you want to order - give us a call or order online. With an online account you can keep your details up to date, inform us of changes to your prescription, or quickly reorder items.If you already use SecuriCare but want to create an online account, continue with the form but ensure you supply the phone number and email address we already have on record for you.If you’re only looking for one-off samples without joining our home delivery service, please visit our sister company, CliniMed. Account registration is only open to UK residents. I am a UK resident Contact detailsComplete this form if you wish to register for our free home delivery service and nominate SecuriCare as your preferred prescription provider. If you only want one-off samples without joining our home delivery service, please visit our sister company, CliniMed. First name * Surname * Email Address * Confirm your email address * Email addresses do not match Telephone * Next: login detailsIf you already have an account, please log in.Log in detailsCreate a secure password so we can set up an online account. But don’t worry… if you prefer to order over the phone that’s fine by us (we love to chat!). Create a password * Confirm your password * Passwords do not match Your password must be at least 8 characters, must contain at least one number, and include a mix of upper and lowercase letters. Next: find your GP BackFind your GPWe go the extra mile so you can get on with life, hassle free. Pop your GP’s details in below and we’ll arrange for them to send your prescription directly to us.Did you know we have a fully licensed pharmacy on-site too? We can dispense any prescription medicines alongside your appliances. Look up your GP by their postcode Look up your GP by their surgery name Your GP surgery Next: more about you BackMore about youTell us more about you so our friendly team of product specialists can help and guide you. Once your account is created you can return and add more details.Sex at birth * Male Female Date of birth * Day Month Year Areas of care *Stoma type Ileostomy Colostomy Urostomy No Stoma Other Please specify... Custom pouch preferences Don't cut the pouch at all - I'll do it myself Cut it to a specific diameter... Pouch hole diameter: Cut to template * * We'll use the latest template we have for you. If we don't have a template for you, we'll contact you to arrange a consultation.Continence type Urinary Incontinence Faecal Incontinence No Incontinence Which products do you use? Indwelling Catheter Intermittent Catheter Pads Sheath Unknown Other Please specify... Your home addressLook up your address below. This will be used as your default delivery address (you can edit this and add additional addresses later). Start with postcode / street Address 1 Address 2 City County Postcode TermsBy submitting this form, you acknowledge that you are nominating SecuriCare (Medical) Limited as your prescription provider for medical devices and for us to fulfil this request we will contact your GP to obtain copies of your prescription. Tick to confirm you accept the privacy policy and terms and conditions * Stay informed Tick here to receive marketing communications via email from SecuriCare and our sister company, CliniMed Ltd. You can unsubscribe at any time. Submit registration Back
