Cervical Screening - Request to Defer My Next Screening Date

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 Cervical Screening Program.

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

Reason to Defer Screening *
Authorised 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 NCSR as a personal representative or healthcare provider, 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 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.
Acceptance of terms *