Use this form to request a sexual health services appointment.
We provide coil and implant services exclusively to patients registered with a Birmingham or Solihull GP practice. If you are not registered with one of these practices, we will be unable to process your request. Please contact your local service provider for further assistance.
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 0121 773 3737 or visit the surgery in person.