Contraceptive Implant Fitting Form

If you would like to have a Contraceptive Implant fitted please fill in the online form here.

Please watch the Information About Subdermal Implants video.

Contraceptive Implant Fitting Form

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Are you on any medications that may affect the implant – (Anti-Retrovirals / Anti-epileptic medication / Mood stabilisers)? *
Do you have a history of liver disease / inflammatory bowel disease / inflammation of the gallbladder caused by contraception? *
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