Cervical Screening - Request to Nominate a Healthcare Provider

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

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• 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.