Consent for Nexplanon insertion or removal

What does insertion of a Nexplanon IUCD involve? You need to make a telephone appt with Dr Beanland or Dr Perks to discuss the Nexplanon. They will issue you with a prescription for the Nexplanon that you can collect from the chemist. On the day of the procedure you need to bring the Nexplanon with you. A small amount of local anaesthetic will be injected to numb the skin before the implant is inserted into the arm.

  • A tiny scar may form at the site of insertion. There is a risk of bruising, which is temporary, and a small possibility of infection at the site of insertion.
  • A pressure bandage will be applied to reduce bruising after insertion of the device which can be removed after 24 hours.
  • The device will need to be removed by a minor procedure involving local anaesthetic injection to numb the skin and a tiny incision (cut) through which the device can be removed. This may result in a small scar.

Please read this information carefully, and ask your doctor or nurse if there is anything that you do not understand.

Consent for Nexplanon insertion or removal

Information and Consent for Nexplanon insertion

Name
Date of Birth
What method of contraception are you currently using?
Please tick all the boxes below to confirm that you have understood the following instructions for the day of your procedure.
I can confirm that the comtraceptive device I would like fitted is