Ostique Connect Applicant Form
Thank you for your interest in participating in the Ostique Connect trial.

We believe that human connection is an essential component to leading a fulfilling life. That's why we've created Ostique Connect; dedicated to enhancing ostomates' quality of life by fostering meaningful relationships.

By joining the Ostique Connect trial, you'll gain access to a vibrant community of like-minded individuals who share your struggles and triumphs and, if you want to, you can offer support and guidance to fellow ostomates.

Through the trial, you'll have the opportunity to provide feedback and suggestions to ensure that we meet the needs of the community, which will be invaluable as we continue to develop and improve the platform.

To apply for a space for phase two (beginning in February 2024), please complete the form below and the Ostique Connect team will be in touch from 15th February 2024 to confirm whether a space is available.

If you don't take part in the trial, please do not worry! The platform will be open to everyone in the future, once the trial has been completed.

Thank you again for your interest in Ostique Connect.

Love,

The Ostique Team x

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Email *
First Name *
Surname *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Do you currently have a stoma? *
What is your bowel / bladder condition history? (Select as many as are appropriate) *
Required
What are your main goals for the platform? *
Would you ideally like to be matched with... *
Which of these areas would you be particularly interested in exploring on the platform? (Select as many as you like) *
Required
Are you able to commit to using the Ostique Connect platform at least once per week? *
Do you consent to the Ostique Connect admin team contacting you via email? *
Do you consent to the Ostique Connect admin team contacting you via phone? *
Do you consent to being added to Ostique's mailing list? *
Please confirm that you have read and agreed to Ostique's Privacy Policy *
Required
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