Implant Consent

The only contraceptive implant (Nexplanon) is a small, flexible, plastic rod which is inserted under the skin of your upper arm. It lasts for 3 years but you can have it removed sooner if you wish.

The implant slowly releases a low dose of a hormone called progestogen. It is one of the most effective methods of contraception currently available, and you are very unlikely to get pregnant when using the implant.

Irregular bleeding is common when using the implant. Some people might bleed frequently and other people might not bleed at all. The bleeding pattern can change at any time



Please look at the following site for further information; NHSinform



Please complete the implant request form below

This is a 10 number reference that is personal to you, the first 6 numbers of this are your date of birth, this can be obtained from your prescription, your NHS card or you GP practice can give you this.
Please use format day/month/year e.g. 12/05/1979
Enter Email
We needs this to inform them you have had this procedure done. Please provide name of GP and town/area of your practice.

Please ensure you answer all questions.

What do you need ? *
Do you have any medical problems? *
Do you think you could be pregnant? *
Have you had any irregular bleeding? *
If not, please answer none.

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This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.