Family planning

What is your gender?

Please state:

What is your ethnicity?

What is your address?

Which GP are you registered with?

Please note we are unable to see patients who are not registered with a Manchester GP.

Any disabilities we need to be aware of?

Yes

No

Please specify :

Do you require an interpreter?

Yes

No

Which language do you require?

Are you using any form of contraception currently?

Which type of appointment do you require?

Please specify:

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