Expression of Interest for Contraceptive Implant Service

Expression of Interest for Contraceptive Implant Service

If you would like to be contacted about the contraceptive implant service, please complete the form below.

A member of our nursing team will contact you in the near future to discuss the contraceptive implant service and assess whether it may be a suitable option for you.

Please note:

  • Completing this form does not guarantee an appointment.
  • Submitting an expression of interest does not mean the contraceptive implant will be suitable for you.
  • Suitability will be assessed by an appropriately trained clinician.

  • Expression of interest form

    Please tick the box below to confirm your expression of interest in the contraceptive implant service. Submission of this form does not guarantee an appointment or that the contraceptive implant will be suitable for you.
    This form collects your name, date of birth, address and contact details. We will use this information to identify your medical record and contact you regarding your expression of interest in the contraceptive implant service. Please read our privacy policy to learn how we protect and manage your submitted data.
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Page last reviewed: 07 August 2026
Page created: 07 August 2026