Family Planning Consent Form

Preparing for insertion of an intrauterine device (copper coil) or an intrauterine system (mirena/Jaydess/kyleena).

If you are eligible for the coil, we would like to make the process as straightforward as possible on the day of your appointment. If you have any questions, please book a telephone appointment.

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Select Your Surgery

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Personal Details

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May be used to identify you

Please tick the boxes to confirm you have understood and agreed to the following:

Signature

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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