New Customers Home / New Customers New Customer RegistrationThis form is for receiving regular ongoing supplies through the SecuriCare Home Delivery Service. If you only want one-off samples without joining our home delivery service, please visit our sister company, CliniMed.Your DetailsAccount registration is only open to UK residents. First name * Surname * Email Address * Confirm your email address * Email addresses do not matchThis will be your online account log-in name Create a password * Confirm your password * Passwords do not matchYour password must be at least 8 characters, must contain at least one number, and include a mix of upper and lowercase letters.Remember to make a note of this! Telephone * Your 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 Your Doctor’s Details Doctor’s name * Surgery name * Surgery phone number * Your area(s) of carePlease select relevant area(s) of care:*Stoma type Ileostomy Colostomy Urostomy Fistula No Stoma Unknown Continence type Urinary Incontinence Faecal Incontinence Indwelling Catheter User Intermittent Catheter User Pad User Sheath User No Incontinence Unknown Other (please complete) We and our sister company, CliniMed Ltd, would like to update you occasionally about our relevant products and services. Please confirm whether you agree to us holding your details and to being contacted in the ways listed below. You can unsubscribe from our mailing lists at any time by clicking the link in any of our emails, calling Freephone 0800 585 125 or emailing info@securicaremedical.co.uk, and you can view our full privacy policy here. Please tick each relevant box: Yes! Please keep me up to date via... Email Phone Post Join SecuriCare Now
