Apply for a hygiene box

Select products and provide your details

Select your care aids, then enter and review the required information.

Your information is transmitted securely to hauscura7/24 and used solely to review and process your request.

Step 1

Select the products you need

Step 2

Care details

Person in need of care

Fields marked with * are required for the subsequent review.

Title

Ms Mr Diverse Prefer not to say

First name *

Last name *

Date of birth *

Street *

House number *

Postcode *

Town or city *

Different delivery address

Contact person

The telephone number is required in case we have questions about the application.

Email address

Telephone number *

Caregiver

Details of the relative or private caregiver.

Caregiver's surname and first name

Relationship to the insured person

Signature

Sign with a mouse, stylus or finger

Step 3

Review selection and details

Summary

Products

Person in need of care

Contact

Caregiver

Care

Submit

Complete application

After submission, we will review your information and contact you if we have any questions.

Thank you. Your request has been submitted.

Your reference number:

We will review your information and contact you if necessary.

Put together your hygiene box

Select products and provide your details

Select the products you need

Care details

Person in need of care

Contact person

Caregiver

Care and care grade

Signature

Review selection and details

Summary

Products

Person in need of care

Delivery address

Contact

Caregiver

Care