Order Your Just Can’t Wait Card1 Your Details2 Your Condition(s)3 Confirmation & FinishAccessing your FREE digital Just Can’t Wait Toilet Card is simple! All we need is your name and a few details about your bladder or bowel medical condition so that we can suggest the right information and services for you. The Digital Card requires Apple Wallet or Google Wallet to work on your smartphone. Please install prior to download. If you prefer a plastic card, please apply by post here.Your DetailsName* First Name Last Name Email Address* We will send you an email to confirm your order.Telephone*Date of BirthDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920GenderFemaleMaleNon-BinaryPostcode*Do you use any of the following prescription products?Question 1 of 4* Stoma Catheters Sheaths Bowel or Rectal Irrigation Systems* None*not including any suppositories or medicationCatheter Type*SuprapubicIndwellingIntermittentWhat type of Catheter do you use?Which of the following bowel or rectal irrigation systems do you currently use?* Peristeen Qufora Aqua Flush Irypump NavinaDo you suffer from any bladder conditions?Question 2 of 4YesNoDo you suffer from any of the following bladder conditions? Frequency Bladder Incontinence Bladder Incontinence (After Childbirth) Urinary incontinence in children Cystitis Bladder Cancer Urinary Tract Infections Urine Retention Overactive Bladder OtherPlease tick all that apply.Please state:Do you suffer from any bowel conditions?Question 3 of 4YesNoWhich of the following bowel conditions do you suffer from?* Accidental Leakage from the bowel Constipation Diarrhoea Irritable Bowel Syndrome (IBS) Inflammatory Bowel Disease (IBD) Crohn's Disease Ulcerative Colitis Diverticular Disease Bowel Cancer Bowel Obstruction Fecal Impaction Fecal Incontinence Short Bowel Syndrome Coeliac Disease OtherPlease tick all that apply.Please state:Do you suffer from any other conditions that affect your bladder or bowel?Question 4 of 4YesNoDo you suffer from any of the following conditions? Dementia Diabetes Multiple Sclerosis Parkinsons Disease Prostate Problems Spinal Cord Injury Stroke Spina Bifida Brain Injury Cancer OtherPlease tick all that apply.OtherWhich of the following cancers do/have you suffered from?Do you suffer from any of the following conditions? Breast Prostate Lung Melanoma Skin Cancer Non-Hodgkin Lymphoma Kidney Head and Neck Brain, Other CNS & Intracranial Tumours Pancreas Leukaemia Uterus Oesophagus Ovary Stomach Liver Myeloma Thyroid CervixPlease tick all that apply.Terms & ConditionsAgree to T&Cs* I agree to the terms and conditions and understand all details completed will be passed to the Bladder & Bowel Community. Bladder & Bowel Community may contact you to discuss any additional home delivery support they can provide through Bladder & Bowel Home Delivery. Bladder & Bowel Home Delivery is a joint partnership between Bladder & Bowel Community and Bullen Healthcare.Click here to read our terms and conditions and click here to read our privacy policy.Agree to T&Cs* I agree to the terms and conditions and understand all details completed will be passed to the Bladder & Bowel Community who may contact you to discuss the Bladder & Bowel Catheter Nurse support and services they can provide, Bladder & Bowel Catheter Nurse Service is a joint service between Bladder & Bowel Community and Amcare. Amcare can offer Catheter support and home delivery supplies. Amcare is a part of ConvaTec Group PLC.You may withdraw authorisation at any time by writing or emailing the Bladder & Bowel Community. This will also apply to Bladder & Bowel Catheter Nurse Service and Amcare. Click here to read our terms and conditions and click here to read our privacy policy.Opt InIf you would like to opt in to receive further information from Bladder & Bowel Community, please tick all relevant boxes below: B&BC Newsletter B&BC Products and Services Relevant Products and Services from B&BC PartnersOFFICE USECommentsThis field is for validation purposes and should be left unchanged. incontinence Share FacebookTwitterWhatsAppEmailPinterestPrint
