Sexual Health Service: Anglesey and Gwynedd

1. Introduction

Please note -
Do not complete this form if you think you may have any of the following, please contact the clinic direct on 03000 850074 9.00am – 3pm to speak to a Health care professional

- Been exposed to HIV and require Post Exposure Prophylaxis PEP
- Genital ulcers
- Pelvic pain or testicular pain of less than 2 weeks duration
- A man with discharge from your penis or rectum
- You need emergency contraception (morning after pill)
For any of the below please see contact information

- If you have been sexually assaulted in the last 7 days please contact the amethyst sexual assault referral centre on 08081563658
- If you would like to be screened for sexually transmitted infections and do not have any symptoms and are aged 16 or over please go to www.friskywales.org for free postal testing
For all other enquiries please complete the form below:
 

1. Nature of enquiry, (for any other enquiry please see your GP): *

 

2. Name:
*

 

3. Address: *

 

4. Date of birth: *

   DD/MM/YYYY 
 
 

5. Contact number: *

 

6. If you have a preferred call back time, can you please state your chosen time from the following list: