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South Tyneside
Sexual Health Service Survey
Please help South Tyneside Public Heath by filling in your Pharmacy details and questions below. If the form does not work you can email Wendy Surtess direct. (
wendy.surtees@southtyneside.gov.uk
)
Any queries should also be directed to Wendy
South Tyneside Survey
*
Indicates required field
Name
*
First
Last
Pharmacy
*
Pharmacy Address
*
Contact No
*
Contact Email
*
Emergency Contraception Consultation
*
Yes
No - Referral Pathway in Place
No - No Referral Pathway
Emergency Contraception Provided
*
Yes
No - Referral Pathway in Place
No - no referral pathway
Chlamidya Screening
*
Yes
No - Referral pathway in place
No - no referral pathway
how many days a week is emergency contraception available from your service
*
Is there a referal pathway for provision of alternative emergency contraception options. (IUD and/or Ellaone)
*
Yes
No
Submit