Ibstock Surgery - GP Surgery Website. All about your ...



132 High Street Ibstock: 01530 263467Ibstock Barlestone: 01455 299920LeicestershireIbstockhouse@LE67 6JPibstockhousesurgery.nhs.ukNEXPLANON CONSENTPatients Name: …………………………………………………D.O.B: ………………………………………………..…………Address: ……………………………………………………………………………………………..I, …………………………………………….. confirm that I have had a discussion about all forms of contraception and decided to proceed with Nexplanon (Progesterone only implant).The benefits of this are:-Over 99% effectiveRapidly reversible method of contraception (Can ovulate as soon as six days following removal)Lasts up to three yearsThe risks of the procedure are:-Bruising/bleeding/infection at site of insertionMigration of the implant (although should always be felt under the skin)The side effects of the implant include:-Bleeding disturbance – irregular periodsMood changes, loss of libido, acne, headaches, weight changeImplanon cannot protect you against sexually transmitted infectionsI can confirm that I am not pregnant at the time of insertion (I have abstained from sexual intercourse since my last menstrual period/I have used a reliable form of contraception until the time of insertion).Please keep the dressing in place for 24 hours post insertion and avoid heavy lifting for the next 48 hours to avoid excess bruising.Your periods may be erratic and irregular. If it becomes heavy please see Dr Luke or Dr Houghton. This does not mean that you need to have the implant removed.Please use an additional form of contraception for seven days, unless otherwise discussed with the doctor or practice nurse.Signature of clinician: ..............................…………………………… Date: ………………………………Signature of patient: …...........................……………………………. Date: ……………………………… ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download