SCN Discharge Pack Order Form

Please fill in the below form with your hospital details, followed by the patient's waistband information.

If you need help completing the form or if you have any queries regarding product codes, descriptions and sizes please contact us at customersupport@cuiwear.com or Tel: 0166 262 4333.

SCN - Discharge Pack Order Form


CUI Wear Logo

Order Details



Product Details



By clicking the send button, I confirm I am receiving from CUI Wear, Medalin Group, Caldow House, Crescent Road, Lutterworth, LE17 4PE goods which are being supplied to the hospital for patient use only.

*Ensure that all details have been checked before submitting this form.


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At CUI International Ltd we are committed to protecting and respecting your privacy. The personal information on this form will be used to assist in the preparation of your order. We will only keep your personal data for as long as required for the stated purpose; your details will be stored securely during this time. CUI International Ltd company registration number is 02018517 and our registered address is: CUI International Ltd, Medalin Group, Caldow House, Crescent Road, Lutterworth, LE17 4PE.