Request Supplies - Individuals - Fecal and Urostomy

Request Supplies – Individuals

Friends of Ostomates Worldwide – USA (FOW-USA) is a volunteer-run, non-profit organization. Our mission is to receive donated ostomy supplies and to ship them around the world to hospitals, clinics, support groups and individuals in countries where ostomy products are not available to those in need.

Ostomates and organizations donate supplies to us. Then, volunteers sort and pack the supplies for shipment to you. While we try to choose types and sizes of products that you request, we may not be able to meet all your needs. We can only pack supplies that are available from the donations to us. We require that these items not be sold.

One-Piece and Two-Piece Colostomy & Ileostomy products: may be a mix of several brands.

Urostomy products: may be a mix of brands, leg bags and night drainage equipment.

Ostomy Accessories: Skin prep wipes, adhesive remover wipes, paste, powder, seals, skin barriers, belts, etc., are packed when available.

A detailed packing slip is attached to each carton.

Products are for humanitarian purposes – not for resale.

To request supplies, complete the information below and a coordinator from FOW-USA will contact you regarding your request.

* items below are required.

FECAL AND UROSTOMY REQUEST OF SUPPLIES

FOW-USA provides supplies free of charge for your personal use and pays the shipping charges to your port of entry. FOW-USA does not pay duties, customs charges, storage charges, or transportation to your final destination. It is your responsibility in advance to secure all documents necessary to import the shipment as a duty-free charitable donation.
I have read the above and agree to these terms for requesting a donation from FOW-USA. I will pay any duty, customs charges, storage charges, or transportation to my final destination that my country will ask me to pay.*
- Yes
- No
Thank You for contacting FOW-USA. We can not send supplies without knowing that you are able to pay any Customs fees and are able to import our charitable donation to you. Please let us know when you have the ability to do so.
I reside in the USA or a USA Territory:
- YES, and the supplies are for my PERSONAL USE
- YES, and the supplies are for someone who lives outside the USA or USA territory
- NO, and supplies are for someone who lives outside the USA
Our organization, Friends of Ostomates Worldwide-USA (FOW-USA), ships supplies outside the USA to those in need. We recognize there is a need in the USA and offer the following list of resources that may be able to provide you with assistance:

The United Ostomy Associations of America website lists resources in the USA. The link to that page is: https://ostomy.org/emergency-supplies.

Contact your nearest ostomy support group to see if they host an ostomy supply closet or know of local resources. The link to that page is https://www.ostomy.org/support-group-finder/. Contact a wound/ostomy clinic or hospital in your area to talk with an ostomy nurse. The nurse may have contacts for supplies.

Major manufacturers may offer patient assistance programs to those who are uninsured and/or underinsured and meet income requirements. Each company sets eligibility. Contact the manufacturer directly to learn if such a program is available and if you meet the eligibility criteria.

Offerup.com, Craigslist, Facebook, etc. - sometimes people list ostomy supplies at a reduced rate or for free. Please note we cannot vouch for their reliability, only that supplies are sometimes offered on their site.

ConvaTec Patient Assistance Program
800-422-8811
https://meplus.convatec.com/articles/patient-assistance-program/

Coloplast Patient Assistance
877-781-2656
www.coloplast.us

Hollister
888- 808 -7456 option #5
Program has specific guidelines and requires documentation. Should the patient qualify they can receive 6 months’ worth of supplies.

Please do not fill out the remainder of the form.
Individual Information
Name*
First Last
Country*
Date*
MM slash DD slash YYYY
Ship To
Name*
First Last
Company (if applicable):
Street Address*
Address Line 2
Address Line 3
City*
State / Province / Region*
Country*
Country
Postal Code*
Local Phone (Include Country Code)*
Email*
Product Selection Information
Yes, I use BOTH, fecal and urostomy pouches
- Yes, I use BOTH, fecal and urostomy pouches
Fecal Pouch Type:*
Mark only one
- One-Piece Pouch
- Two-Piece Pouch
- I can use One-Piece or Two-Piece pouches
Please measure the diameter of your STOMA.

Find the opening size on a measuring guide that easily fits around your stoma. Measure your stoma diameter at the base of your stoma, with no skin showing. See image below. If your stoma is oval, measure the widest diameter. If you do not have a measuring guide, click the link below.

Click the following to print out a stoma measuring guide:

https://www.coloplast.us/Global/US/Professional/ClinicalTools/Digital%20stoma%20guide.pdf
The diameter of my FECAL STOMA is:*
- 16mm
- 19mm
- 22mm
- 25mm
- 29mm
- 32mm
- 35mm
- 38mm
- 41mm
- 44mm
- 51mm
- Other (please explain in detail)
Other (please explain in detail):
FOW-USA will determine and ship the proper flange/barrier size needed for you depending on the STOMA diameter checked above.
FECAL Flange / Barrier Type desired:*
Mark only one
- Flat
- Convex
- I can use Flat or Convex
Example of a convex skin barrier
How many DRAINABLE Fecal Pouches do you use per month:*
Mark only one
- 5
- 10
- 15
- 20
- Other (please enter monthly usage below after selecting)
Other (please enter monthly usage):
How many CLOSED Fecal Pouches do you use per month:*
Mark only one
- None
- 10
- 15
- 20
- Other (please enter monthly usage below after selecting)
Other (please enter monthly usage):
Do you require fecal ostomy irrigation equipment?*
- Yes
- No
Urostomy Pouch Type:*
Mark only one
- One-Piece Pouch
- Two-Piece Pouch
- I can use One-Piece or Two-Piece pouches
Please measure the diameter of your STOMA.

Find the opening size on a measuring guide that easily fits around your stoma. Measure your stoma diameter at the base of your stoma, with no skin showing. See image below. If your stoma is oval, measure the widest diameter. If you do not have a measuring guide, click the link below.

Click the following to print out a stoma measuring guide:

https://www.coloplast.us/Global/US/Professional/ClinicalTools/Digital%20stoma%20guide.pdf
The diameter of my UROSTOMY STOMA is:*
- 16mm
- 19mm
- 22mm
- 25mm
- 29mm
- 32mm
- 35mm
- 38mm
- 41mm
- 44mm
- 51mm
- Other (please explain in detail)
Other (please explain in detail):
FOW-USA will determine and ship the proper flange/barrier size needed for you depending on the STOMA diameter checked above.
UROSTOMY Flange / Barrier Type desired:*
Mark only one
- Flat
- Convex
- I can use Flat or Convex
Example of a convex skin barrier
How many Urostomy Pouches do you use per month:*
Mark only one
- None
- 10
- 15
- 20
- Other (please enter monthly usage below after selecting)
Other (please enter monthly usage):
Do you require LEG BAGS (if available):*
- Yes
- No
Do you require night drainage equipment (if available):*
- Yes
- No
PLEASE PROVIDE ADDITIONAL COMMENTS OR QUESTIONS:
Accessories will be automatically shipped if available.
We ask you to send us pictures and stories of how our donation makes life better for you. Your stories and pictures may be used in our newsletter, Facebook and Instagram posts, Website and any other social media to raise money to pay for shipping the supplies to you.
Please confirm your consent to use the stories you provide us in our newsletter, Facebook and Instagram pages and website:
- Yes
- No