Use this service to request for intrauterine contraception (coil). This service must be used by the patient that is requesting a coil.
If an appointment with an interpreter is required to help with completing this questionnaire, please phone us on Shady Lane 0121 389 2222 or Streetly 0121 389 2222.
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
You can also phone us on Shady Lane 0121 389 2222 or Streetly 0121 389 2222.