Request a free bowel test kit

The National Bowel Cancer Screening Program offers a free, simple test for eligible Australians to reduce illness and death from bowel cancer.

You are eligible to do the screening test every 2 years if you:

are aged between 45 and 74
have a green Medicare card or registered as a Department of Veterans' Affairs customer
have an Australian mailing address.

Use this form if you are:

aged 45 to 49 to request your first free bowel cancer screening kit
aged 50 to 74 and didn't automatically receive your last kit or if it was damaged, misplaced, or expired.

Not sure if you should request a kit? Call our Contact Centre on 1800 627 701.

_{Note: Fields marked with an asterisk (*) are mandatory.}

Request a free bowel test kit

Are you completing this form for yourself? * Yes No – as a healthcare provider on behalf of a patient No – as an authorised personal representative on behalf of someone else

Your details:

Participant details:

Patient details:

Date of birth *

By requesting a kit, you are joining the National Bowel Cancer Screening Program.

Your next test kit will automatically be mailed every 2 years after your last screening test is completed.

Provide given name(s) and family name, as recorded with Medicare:

Given name(s) *

Family name *

Medicare, NCSR ID, or Department of Veterans' Affairs (DVA) number *

Medicare number *

NCSR ID number *

The number displayed at the upper right of your bowel screening letter or lower left of your cervical screening letter

Department of Veterans' Affairs (DVA) number *

Postal address *

Suburb *

State *

Postcode *

Your postcode shows you live in a hot area of Australia. To help protect your samples from heat, we usually send kits during cooler months.

Please confirm when you would like to receive your kit: Mail the kit now Mail the kit in ${newMonth} when the average monthly temperature has cooled

We require an email address so we can contact you if there are any issues processing your request. If you prefer not to share your email or do not have one, please call our Contact Centre at 1800 627 701.

Email address *

If you would like the participant to be contacted if there are any issues processing this request, please provide their email address.

Email address

If you would like your patient to be contacted if there are any issues processing this request, please provide their email address.

Email address

Phone number

Reason for requesting a kit *

Reason for requesting a replacement *

Please describe your other reason for requesting a kit *

Reason for requesting a replacement *

Please describe your other reason for requesting a kit *

Reason for requesting a kit *

Reason for requesting a replacement *

Please describe your other reason for requesting a kit *

Healthcare provider details:

If you are filling in this form as a healthcare provider on behalf of a patient, please provide your name and contact information.

Given name(s) *

Family name *

Medical practice name *

Please provide a medical ID number *

Medicare Provider number *

State and Territory Access Number (STAN) *

Medical practice street address *

Please ensure the address matches the one registered against your medical ID number

Suburb *

State *

Postcode *

We require an email address so we can contact you if there are any issues processing your request.

Email address *

Phone number

Authorised personal representative details:

To fill in this form as an authorised personal representative, your details must be registered with the NCSR as the screening participant’s personal representative, otherwise we will not be able to process your request.

If you are unsure, please call our Contact Centre on 1800 627 701 before filling in this form.

Given name(s) *

Family name *

Date of birth *

Postal address *

Suburb *

State *

Postcode *

We require an email address so we can contact you if there are any issues processing your request.

Email address *

Phone number

What is your relationship to the participant *

Please describe your relationship to the participant

Any personal information provided to the NCSR, including your email address, will only be used to assist in processing this request.

For more information on how personal information is handled, view the privacy policy and frequently asked questions.

I will keep my collected samples cool (below 30°C, preferably in the fridge) and will return them as soon as possible, following the instructions in the kit.
I am requesting this kit for myself and understand I will only be sent the kit if I am eligible for the National Bowel Cancer Screening Program.

I will advise the participant to keep their collected samples in a cool place (below 30°C, preferably in the fridge) and to return them as possible, following the instructions in the kit.
I am requesting this kit as the participant's personal representative, with their consent, and understand the kit will only be sent if they are eligible for the National Bowel Cancer Screening Program.

I will advise my patient to keep their collected samples in a cool place (below 30°C, preferably in the fridge) and to return them as soon as possible, following the instructions in the kit.
I am requesting this kit as the participant's healthcare provider, with their consent, and understand the kit will only be sent if they are eligible for the National Bowel Cancer Screening Program.

Acceptance of terms * I have read, understood and agree to these statements

National Bowel Cancer Screening Program

National Cervical Screening Program

National Lung Cancer Screening Program

About the National Cancer Screening Register (NCSR)

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Request a free bowel test kit

You are eligible to do the screening test every 2 years if you:

Request a free bowel test kit

Your details:

Participant details:

Patient details:

Provide given name(s) and family name, as recorded with Medicare:

Healthcare provider details:

Authorised personal representative details:

Important information

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