NHS Somerset Health Service

DIY chlamydia postal kits for 16-24 year olds only.

If you are outside of the 16-24 age range, we are unable to provide you with a testing kit. Please see you doctor or local sexual health clinic for advice.

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.

Your Name :

Date of Birth :

Gender

Women only - please select your kit type

Address where you would like your test kit sent :

Email address (optional) :

Where did you hear about the programme?

Other :

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.