Cervical Screening - Request to Cease Contact and Correspondence

Use this form to stop screening program-related correspondence/notifications being sent from the National Cancer Screening Register for the National Cervical Screening Program.

You can either type your date of birth in (dd/mm/yyyy) or use the date picker

Reason to Cease Contact and Correspondence *
Cease Until *
Authorised personal representative

Fill in the form below so we can process your request.

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.

You can either type your date of birth in (dd/mm/yyyy) or use the date picker

View the privacy policy

  • I acknowledge that I will no longer receive any contact or correspondence from the National Cancer Screening Register (NCSR) for the National Cervical Screening Program for the period of time I have nominated. Any information relating to future cervical screening will continue to be recorded on the NCSR and can be viewed by my healthcare providers.
  • I may withdraw my request at any time by completing a withdraw request form, or by calling the contact centre on 1800 627 701.
  • I declare that I am the participant or their authorised personal representative.
  • I acknowledge that my selected request(s) will be actioned.
Acceptance of terms *