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BedfordshireBerkshireBuckinghamshireCambridgeshireCheshireCornwallCumberlandDerbyshireDevonDorsetDurhamEast YorkshireEssexGloucestershireHampshireHerefordshireHertfordshireHuntingdonshireIsle of WightKentLancashireLeicestershireLincolnshireMiddlesexNorfolkNorth YorkshireNorthamptonshireNorthumberlandNottinghamshireOxfordshireRutlandShropshireSomersetStaffordshireSuffolkSurreySussexWarwickshireWest YorkshireWestmorlandWiltshireWorcestershireAnglesey/Sir FonBrecknockshire/Sir FrycheiniogCaernarfonshire/Sir GaernarfonCarmarthenshire/Sir GaerfyrddinCardiganshire/CeredigionDenbighshire/Sir DdinbychFlintshire/Sir FflintGlamorgan/MorgannwgMerioneth/MeirionnyddMonmouthshire/Sir FynwyMontgomeryshire/Sir DrefaldwynPembrokeshire/Sir BenfroRadnorshire/Sir FaesyfedAberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBerwickshireButeshireCromartyshireCaithnessClackmannanshireDumfriesshireDunbartonshire/DumbartonshireEast Lothian/HaddingtonshireFifeInverness-shireKincardineshireKinross-shireKirkcudbrightshireLanarkshireMidlothian/EdinburghshireMorayshireNairnshireOrkneyPeeblesshirePerthshireRenfrewshireRoss-shireRoxburghshireSelkirkshireShetlandStirlingshireSutherlandWest Lothian/LinlithgowshireWigtownshireCounty AntrimCounty ArmaghCounty DownCounty FermanaghCounty TyroneCounty Londonderry/Derry

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BORING BUT THE IMPORTANT STUFF DISCLAIMERS

1. Your name, address and details will be held and TREATED AS HIGHLY CONFIDENTIAL INFORMATION, used solely by the IOW Chlamydia Screening Programme and the Department of Health; we will not pass this information onto any one else.
2. Unfortunately we cannot accept any responsibility for any damages or loss whatsoever caused by the interception of your personal information.
3. The information you email/supply to us electronically is transmitted in a non-secure way, there is a chance that your information may be intercepted and viewed by someone else.
4. The form must be fully completed before sending off to us, as it may result in delayed/non despatch of your test. The test will be sent to you in a plain brown A5 envelope marked Private and Confidential.
5. Your postal kit form must be completed and filled out in full. We REQUIRE AT LEAST TWO METHODS OF CONTACT TO ADVISE YOU OF YOUR RESULT. You shall only be contacted by your preferred method. Failure to complete the form could result in the test not being processed.

tick this box if you understand and accept the above items.