Order a postal kit

This service is only available to people aged 16 - 24 and living in Stoke-on-Trent. Do NOT request one for anybody else. If you are aged 25 or older, click here.



What is your sex?
 Male      Female  
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What is your date of birth?
  

First name
    
Last name
  
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Your address
House name or number
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Street name
Town or city

Postcode

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B-clear can only provide FREE Chlamydia Screening for people living in the areas specified. We need your post-code to make sure you are eligible. Your confidentiality is important to us. We will not use or share this information with anyone not connected with the Chlamydia Screening Programme and we will not post anything to you unless you give us permission to do so.
Your mobile number

Your telephone number (including area code)


Your ethnicity  
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 White British  White Irish
 Other White  White and Black Caribbean
 White and Black African  White and Asian
 Other White Mixed  Indian
 Pakistani  Bangladeshi
 Other Asian  Caribbean
 African  Other Black
 Chinese  Any Other Ethnicity
 Prefer Not to Say  

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