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Australia - B. Braun Australia Pty. Ltd

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Intermittent Catheters

Bridge Program

If your patient is eligible for NDIS, iCare, TAC, NIISQ, WorkCover, DVA or other fully funded schemes; but waiting for their funds to be approved, we will temporarily bridge the gap and provide them with intermittent catheters*.

Please note, this is not a sample / ward stock request form. If you need samples, please visit our website or call 1800 172 182 or email: samples.au@bbraun.com.

*on monthly basis for maximum 2 months or total 8 boxes (240 catheters)

Fields marked with an asterisk are required.

Salutation

Mr. Mrs. Neutral

Clinician details

First Name

Last Name

Organization

Street

Postal Code

City

State

Country

You have discussed sharing your patient details with B. Braun and your patient agrees? *

Patient details

First Name *

Last Name *

Email *

Phone *

Street *

Postal Code *

City *

State

Country *

Funding details

What insurance do you have? *

When do you expect the funding to be approved? *

Product details

Select a suitable Actreen intermittent catheter *

Select the format of the catheter *

Select suitable size *

Any other requirements

Marketing Permission

Yes, I would like to receive additional information about relevant therapies, products, solutions or events from B. Braun and its contracted distribution partners in future.

B. Braun Australia is the responsible organisation

The protection of the personal data of our customers is very important to us and we take it very seriously. Your personal data is subject to data protection and the collection and storage is subject to Australia Privacy Laws and our Privacy Policy. Under no circumstances will we pass on your personal data to third parties outside of the B. Braun Group or use or store them for any other purposes. Our staff has been trained to handle personal data and is obliged to comply with the data protection regulations.

Data Protection

I have read the data protection policy and agree with processing of my personal data according to the data protection policy. I can cancel this approval at any time.

Bridge Program

Funding details

Product details

Thank you very much for your request!

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