Leamington Primary Care Network Coil Form

Coil insertion/replacement form

The Leamington primary care network is made up of the 8 practices based in the area. We work together to improve the care of all patients in Leamington. To this end the network has established a service to provide long acting contraception closer to home. Patients from Cubbington Road, Sherbourne, Croft, Waterside, Whitnash, Spa & Warwick Gates are all eligible. 

Long-acting contraception can provide a safe and effective method of contraception. 

There are two main groups of of coil:

  • The hormonal coil (an intrauterine system, or an IUS for short)
  • And the non hormonal coil (an intra-uterine device, or IUD for short)

The hormonal coil (IUS) can be used for contraception and also as part of hormone replacement therapy. There are now several types availabe - these vary in amount of hormone released, size and length of time that contraceptive cover is provided. Only the Mirena coil can be used as part of HRT. 

The non-hormonal coil (IUD) can only be used for contraception.

The NHS choices  and sexwise website contain more information about the differences between the non-hormonal and hormonal coils.

If you are considering using a coil or would like to have a current coil replaced replaced please:

  • Read through this information
  • Watch the video below
  • Read through the attached consent form
  • Complete a consultation with your GP & agreed that a coil would be the best option for you
  • And then submit the online form below. We will then contact you to arrange an appointment.

Please fill in as much information as possible to help us arrange your appointment efficiently.

Following this is you have any queries please email: 


If you do have to cancel your appointment with less than a weeks notice please email the above address but also contact the practice where your appointment is booked. This is to ensure the appointment can be used by someone else. All other queries should only be directed to this email address.

Some of this information will already be included in your medical notes but this is a good opportunity to update any changes.



Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. This service is only for patients registered at GP practices within the Leamington Primary Care Network. Forms must be completed in the UK due to GDPR regulations.


Personal details
Appointment details
It is unsafe to fit a coil if there is a risk of pregnancy. For this reason it is essential that you are reliably using contraception or abstaining from sex for 3 weeks prior to your appointment. If you are having a coil (which is in date) replaced you should use alternative contraception or abstain from sex for 7 days before the appointment. This is to avoid pregnancy if there difficulty in fitting the replacement coil.
If you would like a hormonal coil for contraception and have a preference relating to the type please also include these details here
Please write N/A if not applicable

If your current coil is over due it's change (which should be after 3 years for the Jaydess, 5 years for the Kyleena, 5 years for the Mirena and 5 or 10 years for a copper coil) then you must ensure you are using alternative contraception or have abstained from sex for at least 3 weeks prior to your appointment. If this is not the case we will be unable to safely change the coil.

Please write N/A if not applicable
Further information

As previously mentioned it is really important we do not fit a coil if there is a risk of pregnancy.

If you are having your coil replaced and it is within date it is also important to use condoms or abstain from sex for 7 days prior to the appointment. This is because sperm can survive for up to 7 days, and so if your current coil is removed and there is difficulty inserting the replacement there could be a risk of pregnancy if you have had sexual intercourse in the week prior to the appointment.

Not everyone has a regular cycle. If you do not know the exact date please select the closest possible or write N/A if not applicable

To safely fit a coil we also want to ensure there is no risk of sexually transmitted infections.

If you have no current symptoms of a sexually transmitted infection but are concerned you may be at risk you can request an STI screen to be delivered to you at home via this link: https://www.freetest.me/

If you do have symptoms then please contact the sexual health clinic. Details can be found on this link: https://www.sexualhealthwarwickshire.nhs.uk/clinics.php

Some medical problems mean that certain methods of contraception are not suitable. Please fill in the following information:

Knowing some obstetric information can also help us manage your appointment.

There is a higher risk of complications when fitting a coil if you are within 12 weeks of giving birth. If you have recently had a baby ideally we would suggest using alternative contraception until you are 12 weeks post natal and we will arrange your appointment for after this time period
And a final few bits of information

We can fit a coil if you are having your period - in fact sometimes this makes it easier! So please do not cancel your appointment if you are bleeding.

If the answer is no then you must complete this first prior to submitting the form

Thank you very much for completing this form. We will contact you as soon as possible.

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Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

Information submitted through all secure forms, with the exception of the Leamington Primary Care Network Coil insertion/replacement form and Implant insertion/replacement/removal form, is secured with a private key and is accessed over a secure connection by nominated staff. Information submitted through the Leamington Primary Care Network Coil insertion/replacement form and Implant insertion/replacement/removal form is sent to The Leamington Primary Care Network via secure email.

We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 365 days.

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