Sign up to Coloplast Care

Please fill out the below form to sign up for Coloplast Care. After submitting your information, we will get in touch with you.

Join Coloplast® Care Malaysia now!
 
 
 
 
 
 
 
 
 
I consent to the processing of my data.
 
Read the full consent information by clicking on 'read the consent' below.
 
Personal data
I consent to Coloplast using my personal data above and my sensitive health information to provide Care program services (advising on use of ostomy appliances, phone support, home visits etc.), and feedback to improve Coloplast’s products and services. I also agree to receive calls, mails and if necessary, home visits by Coloplast representatives to assist me in product usage, orders, troubleshooting and updates.
 
*Marketing consent (optional)
I would like to receive newsletters that are relevant to my medical condition, brochures and other marketing materials and information about Coloplast’s products, including free samples, and services through e-mail, text, phone call and/or mail. I understand that I can withdraw my consent at any time.
 
 
Read the consent form

As the responsible data controller Coloplast A/S (with primary address on Holtedam 1, Humlebaek, Denmark and local addresses on Level 3, Menara Axis 2, Jalan 51a/223, Seksyen 51,46100, Petaling Jaya, Selangor, Malaysia (“Coloplast”) will ensure that the personal information provided in this form and in subsequent exchanges regarding the Care program (including in face-to-face meetings and via social media such as WhatsApp, Line and Facebook) (“the personal data”) is treated with care and in accordance with applicable laws and regulations. Coloplast will only process the provided patient information to provide Care program services (advising on use of ostomy appliances, phone support, home visits etc.), send samples, marketing materials and offers, and to improve Coloplast’s products and services, and the legal basis for this is consent, cf. article 9(2)(a) of the EU General Data Protection Regulation (“GDPR”) and Section 6 and 40 of the Personal Data Protection Act 2010. Coloplast will only process the information about healthcare professionals and other persons for the purpose of providing Care program services and to facilitate communication. The legal basis for this is Coloplast’s legitimate interest in communicating about the Care program and maintaining a relationship with such persons, cf. article 6(2)(f) of GDPR.

Coloplast’s employees will process the information exclusively for the specified purposes. Coloplast will in certain cases use systems run on third-party platforms. Such cases will imply a transfer of data to the third parties, but solely for the specified purposes and with the third parties acting on instruction from Coloplast. Data may be collected and processed across the Coloplast network, which may entail processing of personal data inside and outside the European Economic Area. In such cases, an adequate level of protection will be ensured by the third parties being subject to the standard contractual clauses on data protection adopted by the EU or to an EU-approved certification mechanism on data protection. For further information about this please consult Coloplast’s data protection officer (details below).

The personal data will be kept as long as you are signed up the Care program. You will be asked to renew your subscription for the Care program within five year periods. The data will be deleted when you cancel or decline to renew your subscription to the Care program, or if you withdraw your consent or request deletion of your data (which also will constitute termination of your subscription for the Care program).

You can write to privacyrequests@coloplast.com at any time to request: (i) access to your data, (ii) rectification or deletion of your data, (iii) restrictions in respect of the processing of your data, (iv) to receive your data in machine-readable format (data portability), or (v) to withdraw your consent. Exercising the above rights will not result in any adverse consequences on your part. If you wish to learn more about how Coloplast processes personal data, please visit www.coloplast.com/global/privacy-notice.

Coloplast has appointed a data protection officer. If you have any questions regarding the way Coloplast processes personal data, please email our data protection officer at dataprotectionoffice@coloplast.com or send a letter addressed to Coloplast, attn. Data Protection Officer. Complaints regarding the way Coloplast processes personal data should also be sent to our data protection officer. If you are dissatisfied with the way Coloplast treats a complaint received, you have a right to lodge a complaint with the relevant supervisory authority. In Denmark, the relevant authority is the Danish Data Protection Agency (www.datatilsynet.dk). In Malaysia, the relevant authority is the Personal Data Protection Commissioner (http://www.pdp.gov.my/)

For other queries or questions (e.g. about the Care program) you may contact Coloplast via e-mail at mycoloplastcare@coloplast.com

You must be logged in to submit this form. If you are logged in and still cannot post, make sure "Do not track" in your browser settings is disabled.