Coil Removal Form

A coil must be removed by a trained doctor at the surgery – either Dr Moss or Dr Waters.

If you are having your coil removed and don’t want any risk of pregnancy please avoid sex for 7 days before your appointment or use condoms. This is because sperm can survive for up to a week.

If you wish to use another form of contraception following the removal of your coil please state this below in the form. You may wish to start an alternative form of contraception before the coil is removed to ensure that it is effective immediately.

If you wish to have your coil removed and replaced with another, please do NOT complete this form. Instead complete the coil replacement form

On the day of your appointment, we recommend that you take a painkiller (such as paracetamol or ibuprofen) up to one hour before your appointment and have something to eat and drink. It is ok to have your procedure if you are bleeding. Please be aware that children will not be able to come into the room with you when you have the procedure and there are no childcare facilities.

After the procedure, most people will be able to carry on their activities as usual but it is useful to have a backup plan and someone to call to take you home if needed.

Step 1 of 2

Date of Birth  Required
I understand that unless I abstain from sex or use alternative contraception for 7 days prior to my appointment there is a risk of pregnancy  Optional
I confirm that I am a registered patient at Southam Surgery  Optional

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