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OSTOMY CONTACT FORM


Please fill in as many fields as you wish but DON'T FORGET to give me at least an email address, thanks.

Please take the time to fill out this contact list form so that others may contact you in times of need or just for a general chat.


Please note that it may take a few days for your post to be entered onto the "Contacts" page.


Your Name:

Your Email Address:
DON'T FORGET!!!!!!!!!!!!!

How old are you?

What city/country do you live in?:

Your ICQ Contact Number:

Type Of IBD (Inflammatory Bowel Disease)
(please enter, as this helps me know what category to put your info in):
Ulcerative Colitis
Crohns Disease
Indeterminate Colitis
Crohns/Colitis
Hirschsprungs Disease
Cancer
Familial Polyps

Other:

Type Of Ostomy Surgery
(please enter, as this helps me know what category to put your info in):
Ileostomy
Colostomy
Urostomy
BCIR
J Pouch
Kock's Pouch
Resection
No Surgery Yet

Have you experienced pregnancy with an ostomy?

Any additional info you'd like to add: