LARCs Request

Use this form if you have been directed here by Alchester Medical Group, to request a LARCs fitting or replacement (or removal if you are a patient at Alchester Medical Group).

Please note: when we contact our patients, generally our default form of electronic communication is via email - so please check your junk mail box in your emails for communications from us.

Page {{ paginatorProps.current }} of {{ paginatorProps.total }} ({{ paginatorProps.percentage }}% completed)
Personal Details
Please double check you've entered the correct email address
You may have been referred to Alchester Medical Group by your GP, we will need to know this information in order to process your request
LARCs Contraception Request
What are Coils?

The coil, also known as an intrauterine contraceptive device (IUCD), sits inside the womb (uterus). Find out more about IUCDs here: https://bit.ly/3vHQszf

A intrauterine system (or IUS) is another type of IUCD device. It also sits inside the womb (uterus). Click here to read more: https://bit.ly/3vHBdql

What are Implants?

A contraceptive implant is a small device that is inserted under the skin in your upper arm. Read more about the contraceptive implant here: https://bit.ly/3P9WnEs

 

Please select one of the following options:

This service is for Alchester Medical Group patients only
 
Please note: if you do not select one of the above options, your request will be rejected

Please only select one option; if you select multiple options your request will rejected

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.

 
Previous Page  
Processing

There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.