Coil (IUD/IUS) fitting pre-appointment questionnaire

Use this service to provide information to the surgery ahead of your coil fitting appointment.

Please complete this form before your appointment. It helps us make sure we can safely fit your coil.

You can use this service if you:

• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

Start now

You can also phone us on 0161 224 5555.