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By ticking this box:

The patient consents to the following:

• The pharmacist to provide them with a supply of oral contraception.

The patients information will be legally shared with:

• NHS England as part of the service monitoring and evaluation, and

• The NHSB SA and NHS England for the purpose of contract management and post-payment verification (PPV).

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By ticking this box you give consent for data sharing, the information you provide will be passed to: your GP.

To inform your GP that you have received oral contraception through the NHS Pharmacy Contraception Service.

If you do not provide consent (by ticking this box), your GP will not be notified.