Bowel Screening - Request to Opt Out

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 NCSR.

Reason(s) for opting out of the Program *
Confirmation
Personal representative

If signing on behalf of the participant, please provide your name and contact information.

Please note: to fill in this form as an authorised representative, your details must exist within the Register as a personal representative. If you are not personal representative within the Register, 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.

View the privacy policy

  • 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 healthcare provider can see I have opted out.
Acceptance of terms *