Order A Chlamydia Test Kit

This test is for young people under age 25 who have no symptoms and who live in South West Essex (Thurrock, Basildon, Billericay and Brentwood). If you have symptoms, please contact your local sexual health clinic. If you live outside of South West Essex (Thurrock, Basildon, Billericay and Brentwood) then please log on to www.chlamydiascreening.nhs.uk for local information

Use this form to request a takeaway kit. The form is totally secure and your information is provided in complete confidence that your privacy is protected.

Please Note: Items marked with a * must be completed.

Full Name *
Date of Birth *
Address 1 *
Address 2
Town *
Postcode *
Email *
Contact No. *
Kit Type *
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