Reception: Clarendon Lodge Implant Form
Implant insertion/replacement/removal form
This form is for Clarendon Lodge patients only. If you are a patient at another practice and would like to request a fitting please contact your own practice initially.
Long-acting contraception can provide a safe and effective method of contraception.
The contraceptive implant is a small rod sited in the upper arm which provides contraception for up to 3 years.
More information can be found on thee NHS UK and sexwise websites.
If you are considering using an implant, or would like to have a current implant replaced or removed please:
- Read through this information
- Watch the video below
- Carefully read through the consent form (PDF, 472KB)
- Complete a consultation with your GP & agreed that an implant would be a suitable option for you
- And then submit the online form below. We will then contact you to arrange an appointment.
Please fill in as much information as possible to help us arrange your appointment efficiently.
Some of this information will already be included in your medical notes but this is a good opportunity to update any changes.
Video: Having a contraceptive implant fitted
Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception 01926 331401. We will start to process your form by the next working day but it will take up to 5 working days to complete. Please DO NOT call before 5 working days as you will not receive a status update from reception or the administrative team. If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over; and for parents or legal guardians of children. Forms must be completed in the UK due to GDPR regulations.
Appointment details
Not everyone has a regular cycle. If you do not know the exact date please select the closest possible or leave this question blank
And a few final bits of information
If the answer is no then you must complete this first prior to submitting the form
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please use one of the alternative methods offered by our organisation.