* Indicates mandatory field
















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




  • 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.


Use this form to delay a future screening date and reminders for a period of time being sent from the National Screening Register for the National Cervical Screening Program.




  • I acknowledge that I can still screen at any time and the results will be recorded on the National Cancer Screening Register 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.


Use this form to choose a/my preferred doctor to receive notifications from the National Screening Register for the National Cervical Screening Program.


Participant


Healthcare Provider



  • I acknowledge that my nominated healthcare provider will be recorded on the National Cancer Screening Register (NCSR) and will be able to access details about me and be contacted if I need to be followed-up in relation to my cervical screening. If I see another healthcare provider for cervical screening, they will also be recorded in the NCSR and will receive information about my cervical screening.
  • 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.


Use this form to opt out of all participation in the National Cancer Screening Register for the National Cervical Screening Program. Read important information about opting out of the Register.



  • I acknowledge that I will not be contacted or be sent any further correspondence from the National Cancer Screening Register (NCSR) for the National Cervical Screening Program. I can still undergo a cervical screening test at any time through a healthcare provider. No further cervical screening information about me will be recorded on the NCSR. My healthcare providers can be informed that I have opted out but will not be able to access my screening details.
  • 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.


Use this form to choose a fictitious name to be used on all register correspondence, notifications and contact in the National Cancer Screening Register for the National Cervical Screening Program.





  • I acknowledge that I (including my personal representative or nominated healthcare provider, if I have one) will receive correspondence from the National Cancer Screening Register (NCSR) or National Cervical Screening Program addressed to my pseudonym. My personal information and screening details will be recorded under my pseudonym on the NCSR. My information and screening details will be directed to my pseudonym.
  • 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.


Use this form to withdraw a previous request made to the National Cancer Screening Register for the National Cervical Screening Program.



Please select request(s) to withdraw


  • I acknowledge that my selected request(s) will be actioned.
  • I declare that I am the participant or their authorised personal representative.


Use this form to request a replacement FOBT kit.





Use this form to delay a future screening date and reminders for a period of time being sent from the National Cancer Screening Register for the National Bowel Cancer Screening Program.





  • I acknowledge that I can still screen at any time and the results will be recorded on the National Cancer Screening Register 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 National Bowel Cancer Screening Program Contact Center on 1800 118 868.
  • I declare that I am the participant or their authorised personal representative.
  • I acknowledge that my selected request will be actioned.


Use this form to opt out of all participation in the National Cancer Screening Register for the National Bowel Cancer Screening Program. Read important information about opting out of the Register.




  • I will not be contacted or receive any future correspondence from the NCSR National Cancer Screening Register for the National Bowel Cancer Screening Program, however you will always receive notification of a positive result;
  • I will not have any future results from the Program recorded on the National Cancer Screening Register;
  • I will not be re-invited to screen for bowel cancer by the Program; and
  • If I have opted out of the Program but then decide to participate by doing the Program test kit, I will be considered a participant in the Program. This means my test results will be recorded on the National Cancer Screening Register and correspondence will be sent to me if necessary.
  • No further Bowel Screening information about me will be recorded on the NCSR National Cancer Screening Register, my authorised HCP can see I have opted out.


Use this form to choose a/my preferred doctor to receive notifications from the National Cancer Screening Register for the National Bowel Cancer Screening Program.


Participant


Healthcare Provider


  • I acknowledge that my nominated healthcare provider will be recorded on the National Cancer Screening Register (NCSR) and will be able to access details about me and be contacted if I need to be followed-up in relation to my bowel screening. If I see another healthcare provider for bowel screening, they will also be recorded in the NCSR and will receive information about my bowel screening.
  • 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.


Use this form to choose a fictitious name to be used on all Register correspondence, notifications and contact in the National Cancer Screening Register for the National Bowel Cancer Screening Program.




  • I acknowledge that I (including my personal representative or nominated healthcare provider, if I have one) will receive correspondence from the National Cancer Screening Register (NCSR) or National Bowel Cancer Screening Program addressed to my pseudonym. My personal information and screening details will be recorded under my pseudonym on the NCSR. My information and screening details will be directed to my pseudonym.
  • 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.


Use this form to withdraw a previous request made to the National Cancer Screening Register for the National Bowel Cancer Screening Program.



Please select previous request(s) to withdraw *

  • I acknowledge that my selected request(s) will be actioned.
  • I declare that I am the participant or their authorised personal representative.