Order online or by text  

Order online

You can order a free kit by filling in the form below.  The service is confidential and your kit will arrive in a brown envelope.  IMPORTANT: You must be at least 16 and under 25 and live in the Birmingham or Solihull area to order a free kit.  If you are under 16 or do not live in Birmingham or Solihull, please contact 0800 953 3399 (Mon – Fri: 9-5pm) for advice or visit your GP.

Name
Sex	Male Female
Address
Postcode
Date of Birth	D: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Mth: 1 2 3 4 5 6 7 8 9 10 11 12 Yr: 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903
How did you hear about the BeSure service
Please fill in ALL above fields

Order by text

You can order a free kit by texting BeSure to 80010.  Please include your name, address, postcode, date of birth and if you are male or female.  Your kit should arrive within 10 working days.

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