Enhanced Access Long Acting Reversible Contraception (LARC) Service (NOT LIVE)

You can use this form to express an interest in accessing the Bellbrooke Enhanced Access LARC service or to refer a patient in if you are a Practitioner in a GP surgery. DO NOT USE – THIS SERVICE IS NOT LIVE

Referral – Long Acting Reversible Contraception
Referral method
Would patient like a copy of this request sending by email? *

Referrers details

Role of Referring Practitioner
Patients GP Practice? *
Referral for