Implant Contraception Self-Assessment

Implant Contraception Self-Assessment Checklist


It is important that you are suitably informed prior to the fitting of your contraceptive implant. Please confirm the following:
I have read the information on contraceptive implant information provided *
I understand that no method is 100% effective and that there is a small risk of failure (less than 1 in 100 over a year) *
I understand the device contains hormones and may have related side effects including breast, pain, weight gain and changes in mood. *
I understand that there is a risk of infection *
I understand that there will be a scar on the inside of upper part of arm *
I understand that the implant may be visible *
I understand thatvery rarely there may be damage to underlying nerves and blood vessels during the procedure *
I understand that in rare circumstances it may take more than one attempt to remove the device and you may need to have this done in hospital *
I understand that the implant may make my periods irregular or they may stop *
I understand that it is not safe to insert an implant if there is a risk of pregnancy *
I am not at risk of pregnancy because: *
Please use this date format: DD/MM/YYYY.