Request Sexual Health Testing

Hello

Chlamydia and Gonorrhoea are the most common infection. They can be easily tested for using a urine sample or self taken “swab”. You do not need to be examined. Please research these infections using NHS websites to see if you are at risk.

Note if you have pain, fever or other symptoms contact the practice directly rather than completing and online request.

Sexual Health Testing

First Name *

Last Name *

Email *

Enter Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Chlamydia and Gonorrhoea Tests

This involves a self taken urine sample (men) or swab. These tests can be taken away and do not necessarily require an appointment. Negative results will be sent by text.

Would you like Chlamydia and Gonorrhoea testing? *

Yes

Phone number for a clinician to contact you *

The practice will be in contact. Please add a comments: *

Things you need to know
· All these infections are treatable
· You do not need to disclose that you have been tested

Privacy Policy

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.

I understand that our communication will primarily occur via text message or phone, so please ensure that your phone numbers are current and accessible.

If you are human, leave this field blank.