Please complete the following to receive your free DIY chlamydia postal kit (please note, we are only able to send to Somerset postcodes only).
All of the below boxes need to be completed to enable us to send you a kit. The kit will come in a plain envelope so delivery is discreet and confidential.
The information that you supply via this web form will be entered into a database and will only be accessed by authorised persons of Somerset PCT or its agents. The information will be retained by Somerset PCT and will be used for the purpose of (a) processing your enquiry, and (b) for statistical and audit purposes. By supplying such information you consent to Somerset PCT storing the information for the stated purpose. The information is processed by Somerset PCT in accordance with the provisions of the Data Protection Act 1998.