High Risk:
< 25 yo and sexually active
> 25 yo with:
1. A new Partner in the past year
2. >1 new partner in the past year
3. partner had >1 partner in past year
Procedure: Insertion of Intrauterine device
Patient Consent
I confirm that the information given by me is correct.
I have read the information leaflet on intrauterine devices.
The risks and side effects of the procedure and the device have been explained to me.
I understand the risk including perforation, expulsion, failure of insertion, failure of device, irregular bleeding, infection and pelvic pain.
I agree to the above procedure.
Thanks for submitting! We look forward to chatting with you!
