* 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.