LARCs Request

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

If you are requesting a coil removal ONLY (not replacement), please contact the practice to make an appointment with one of our nurses (this is only for Alchester Medical Group patients). 

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Personal Details
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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:

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

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:


If you are requesting a Coil Removal ONLY, please contact the surgery (you do not need to fill this form in) on 01869 248585 and request an appointment with one of our Nurses.

For implant removals, please continue to complete the form.

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

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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