Please only use this form if you are female and are currently taking the contraceptive pill.
It is important you select as truthfully as possible so we can provide you with the correct advice and treatment.
All fields marked (*) on this form are mandatory, please complete to the best of your knowledge. By using this form, you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your details.
Please allow 48 hours for your prescription request to be issued and allow the pharmacy time to dispense this for you. If we wish to discuss anything further; you may be contacted at some point, please ensure the mobile number you have provided is correct. By submitting this form you understand and accept these conditions.
Please be aware our Coil Clinic Service has been dispended during this time.
We thank you for your co-operation.
Useful Telephone Numbers
Cardiff & Vale Health Board
When we are closed
Search Local Health Services
Community Health Council
NHS Direct Wales
Vale Of Glamorgan Council
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