Information Request Form Please send me further information about the Urostomy Association. Fields marked with * are required.Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Last Address* Street Address City County Post Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Enter Email Confirm Email I have a urinary diversion I may need to have a urinary diversion in the future I am interested in the work of the Urostomy Association because Type of operation Urostomy Bladder reconstruction/neo-bladder Continent urinary stoma Rectal bladder Please state reasonThe Urostomy Association DVD Request a DVD The Urostomy Association leaflets What is a Urostomy? Active living Expectations of care for patients with an Ileal Conduit (Urostomy) in the Primary Care setting Female sexual matters and pregnancy Membership information and application form Orthotopic/ Neo-bladder/Bladder reconstruction an alternative to a Urostomy Travel information Understanding issues that may arise with a Urostomy Continent Urinary Diversion – Mitrofanoff Male sexual matters Urinary Infections in Urinary Diversions Expectations of care for patients with a Neobladder in the Primary Care setting Expectations of care for patients with a Continent Urinary Diversion (eg Mitrofanoff) in the Primary Care setting How you can help the UA with a legacy What is the Urostomy Association? Here at the Urostomy Association we take your privacy seriously and will only use your personal information to support you and to provide the products and services you have requested from us. Your personal details will NOT be passed to any third-party.Data Consent* I have read the Terms & Conditions and agree to the processing of my data as outlined in the Privacy & Cookie Policy EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. For information on the references used to create documents please click here. Information Urostomy Living with a Urostomy Mitrofanoff Neo-bladder Top Tips Glossary Information Request Form Branch Literature Request Form Suppliers Spare equipment Useful Links
