We are delighted to announce that our coil removal service is now open to patients in the Dundee area where your GP practice has an agreement with Newfield Medical Group to provide this service. Your own GP practice will be able to advise you whether an agreement is in place and whether you can refer to this service using our online form below. It’s important to note that we cannot provide this service to patients not registered at Newfield if there is no agreement in place between ourselves and your own practice.

First name*

Surname*

Date of birth/CHI*

Address (including postcode)*

Daytime telephone number

Email address*

Name of registered GP Practice

Please provide a reason for requesting removal of your coil:*

Date of last smear if known

Result of last smear:
NormalAwaiting treatmentOther

Date of coil insertion if known?

Any Sexually Transmitted Infections in the past eg chlamydia, gonorrhoea?
YesNo

Have you had a new sexual partner in the last 3 months?
YesNo

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.
I consent to the practice collecting and storing my data from this form.

Coil Removal Appointment Request

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