Cervical Screening - Request to Opt Out

Use this form to opt out of all participation in the National Cancer Screening Register for the National Cervical Screening Program.

Read important important information about opting out of the NCSR.

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

Reason to Opt Out *
Authorised personal representative

Fill in the form below so we can process your request.

To fill in this form as an authorised personal representative, your details must be registered with the NCSR as the screening participant’s personal representative, 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

Confirmation
  • 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.
Acceptance of terms *