Cervical Screening Programme – Deferral

This form should be used if your next test is to be postponed. The reason for postponement and new deferral date must be specified.

You will be invited for screening approximately 5-6 weeks before the end of the deferral period.

Required field(s) are indicated by *
Cervical Screening Programme - Deferral

Cervical Screening Programme - Deferral

About you

As it appears on your passport.

As it appears on your passport.

The one used to register with your GP.

Your date of birth is required to verify your identity.

As on your medical record.
This phone number will be used for all correspondence relating to this request.

This email address will be used for all correspondence relating to this request. Please be aware that if you have given anyone else access to your email account they may see responses sent to you.

Please continue completing the form below

Please use date format DD/MM/YYYY (maximum 18 months deferral)
Deferral reason: *