Copper IUD

Please complete this form to request the copper IUD implant through your GP practice.

An IUD is a small, flexible plastic and copper device that’s put into your uterus (womb). It has one or two thin threads on the end that hang through your cervix (the entrance to the uterus) into the top of your vagina.

An IUD works for contraception for 5 or 10 years, depending on the type. If you’re aged 40 or older when the IUD is fitted, it will work for contraception until after the menopause, when contraception isn’t needed.

An IUD is sometimes called a ‘coil’ or ‘copper coil’. There are different types and sizes.

Please click the link below for more information on the copper IUD

Please use format day/month/year e.g. 12/05/1979
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One of our clinicians will contact you on this number in the next few days.

Please ensure you answer all questions.

Do you have any medical problems? *
Any medications? *
Any allergies? *
Have you had any irregular bleeding? *
Any bleeding after sex? *
Any bleeding between periods? *
Do you think you could be pregnant? *
What do you use for contraception at the moment? *

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This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.