New Patients

Moorland offer a one stop service to patients with continence issues and stomas; taking the hassle out of arranging and ordering the most suitable products and delivering them straight to your door at no cost at all.

If you are a new patient looking to order your supplies through Moorland, the first thing we need is to receive a referral from your stoma nurse or urology specialist.

Once we receive your referral from a nurse specialist, if required our nurses will visit you at home to make an assessment on the products that you will require then arrange with our Customer Service team to have these items delivered to your front door.

Following this visit, we will contact your doctor directly and arrange your prescription.

If you have any queries please don’t hesitate to call us on Freephone 0800 652 6667.

New Customer Form


First Name:
 
Surname:
 
Date of Birth: (dd mm yyyy)
Email:
 
House No/Road:
 
Town:
 
Postcode:
 
Contact Number:
 
GP's Name:
 
GP's Practice:
 
Address:
 
Postcode:
 
Products to Order:
 
Additonal Comments:
 
Referral Details
Referred By:
 
Position:
 
Based at address:
 
Hospital and ward:
 
Telephone Number
 
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