Blackpool and Lancashire Sexual Health Service Contraception

On-line requests for certain methods of contraception (excluding the implant and coils) are available for people over 16 years of age who live in Blackpool and Lancashire (excluding Blackburn with Darwen)

If you are under 16, unfortunately you cannot order your contraception on-line - please call the booking line number on 0300 1234 154 to speak to a nurse who will support you with your request.

Method:*
Please call 0300 1234 154 to order this contraceptive option.
You have chosen to request progestogen only pills (POP) by post.

Please read the following leaflet before completing the request form below:

FPA Progestogen only Pill

Please be aware that your order may take up to 2 weeks to arrive.

If you require your pills sooner please do not request pills via the request form below, call 0300 1234 154 to speak with a nurse to arrange collection from one of our clinics.
Have you been issued with the progestogen only pill (e.g. desogestrel, cerazette, cerelle, zelleta, feonalla, Noriday) by this service within the last 12 months?*
Sorry, we are unable to offer you this service online. Please ring 0300 1234 154 to speak to a nurse regarding your request.
Name:*
Date of Birth:*
Date Format: DD slash MM slash YYYY
Address:*
Street Address City ZIP / Postal Code
Sorry, this service is not available in your area.
Contact telephone number:*
Email:*
GP Practice*
What is your ethnic group?*
Prior to issuing you with the progestogen only pill (POP) you need to complete the following questions to ensure it is medically safe for you to take it.
Do you have a bleed whilst you are taking the POP?*
When was your last bleed?*
Have you been at risk of pregnancy in the last 3 months (This may be because you have missed pills or had diarrhoea and vomiting)?*
If you are unsure, please talk to one of our clinicians on 0300 1234 154.
Sorry, you cannot continue online. Please speak to one of our clinicians on 0300 1234 154.
What pill are you currently taking?*
Have you had any unusual vaginal bleeding in the last 2 years , this may include bleeding in between a period or after sex?*
Sorry, you cannot continue online. Please speak to one of our clinicians on 0300 1234 154.
Do you feel you are at risk of sexually transmitted infections?*
You can request a free postal testing kit here: https://www.lancashiresexualhealth.nhs.uk/testing-options.
Have you ever been sexually assaulted?*
You can access support via: bfwh.idva.isva@nhs.net.
Are you allergic to progesterone?*
Sorry, you cannot continue online. Please speak to one of our clinicians on 0300 1234 154.
Are you allergic to lactose, soya or peanuts?*
Sorry, you cannot continue online. Please speak to one of our clinicians on 0300 1234 154.
Are you taking any medications prescribed by your doctor or the hospital?*
What medications are you taking?*
Do you take St John's Wort or any other medications you buy over the counter, online or from any other source?*
What medications do you take?*
Have you ever had breast cancer, or any other cancer?*
Sorry, you cannot continue online. Please speak to one of our clinicians on 0300 1234 154.
Have you ever had gastrointestinal (bowel) problems?*
Sorry, you cannot continue online. Please speak to one of our clinicians on 0300 1234 154.
Have you ever had liver problems or jaundice?*
Sorry, you cannot continue online. Please speak to one of our clinicians on 0300 1234 154.
Have you ever had a blood clot (thrombosis) in your leg or lung or a stroke or heart condition?*
Sorry, you cannot continue online. Please speak to one of our clinicians on 0300 1234 154.
Have you ever had any other serious health conditions, illness or surgery or medical treatments (that we should know about)?*
Sorry, you cannot continue online. Please speak to one of our clinicians on 0300 1234 154.
Have you ever been told by a health professional that the progestogen only pill would be unsuitable for you?*
Sorry, you cannot continue online. Please speak to one of our clinicians on 0300 1234 154.
Do you, or have you ever smoked?*
What do you smoke?*
How many do you smoke?*
Help to stop smoking: Quit Squad
How often do you have a drink containing alcohol?*
How many units of alcohol do you drink on a typical day when you are drinking?*
How often have you had 6 or more units if female, or 8 or more units if male on a single occasion in the last year?*
How would you prefer to receive your contraception?*
Please select a hub:*
How did you find out about this service for accessing your contraception online?*
Please specify:*
Email
This field is for validation purposes and should be left unchanged.

Lancashire Sexual Health Services

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Under 25… and live in Blackpool

Under 25… and live in Lancashire

Contraception