Qufora Ordering and Support

We’re ready to get your patient started. By completing this form, you are confirming that your patient wishes to receive myqufora support for ongoing guidance adopting their product, following your teaching on how to use it.

To help us support your patient safely and effectively, please complete all fields. Your patient will automatically be registered to receive their product from Qufora Direct.

GP Details

Patient Condition

Product Choice

My Irrigation Booklet

Healthcare Professional Details

Please enter your E-Mail address so we can send you a confirmation email.
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INFORMATION
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The information provided on this webpage may be subject to different medical and regulatory requirements in different countries. This information should not be used for diagnosing or treating a health problem or disease. It is not medical advice and is not intended to substitute for the advice of your personal physician or other healthcare provider. Before use of any of our products, always consult the ‘Instructions for Use’ document delivered with the products. The Company cannot answer unsolicited emails requesting personal medical advice; please consult your healthcare provider.