Clinicians: tell us more

*Referrer / Clinician Name

*Referrer / Clinician email

*Referrer's Clinic or Town

Your Patient ID (so you can refer to later if needed)

*Name of other Provider

Practice of Concern (you can tick more than 1)Mgen tested in asymptomatic U. urealyticum tested in asymptomatic U. parvumM. hominisGardnerella Inappropriate HSV serologyInappropriate sample/site type (specify)inappropriate assay (specify)Inappropriate clinical advice (specify)Other (specify)

Extra information (optional)

Clinicians: tell us more

Please tell us more about your experiences of supporting patients reporting use of direct-to-consumer STI tests.

This will help to inform our work with providers to support best practice.