Sexual Health Screening Request

Non-urgent advice:
Check, is this an emergency?

For the form to appear, please click to confirm you have read the emergency information:
When to call 999

Please note, this form cannot be used to request
emergency contraception at this time.

Have you read "When to call 999"?

Yes

How to use this form

Use instead of phoning to contact us about your sexual health.
We aim to respond by the end of the next working day.
Your form is sent to us securely and processed by one of our admin staff.
We may need to call you so please give us a working telephone number.
You can also get direct support from Sexual Health Sheffield

About You

Your Full Name

First Name Surname

Your Date Of Birth

This field is hidden when viewing the form

Age Optional

Address

Street Address ZIP / Postal Code

Your Contact Number

We will call back during practice opening hours by the end of the following working day. We DO NOT enter into email conversations.

Your Email Address

This is only for us to contact you if we cannot get hold of you by telephone and if we feel we need to contact you.