Implant insertion/replacement/removal form

Implants are inserted and removed at the Surgery by Dr Moss.

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.

If you are considering using an implant, or would like to have a current implant replaced or removed please:

*If you are having an implant inserted or an out-of-date implant changed, it is important there is no risk of pregnancy on the day you attend. If there is a risk of pregnancy we will be unable to go ahead with the procedure. Please ensure you have had no unprotected sex for 3 weeks (21 days) before your appointment. Either use condoms or do not have sex.

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Date of Birth  Required
If you currently have an implant, what date is the replacement due?  Optional