Request to Withdraw a Pseudonym

Use this form to withdraw a request for a pseudonym made to the National Cancer Screening Register (NCSR).

Once your request is processed, we will use your legal name as recorded with Medicare for all letters, notifications and contact made through the NCSR for the bowel or cervical screening program.

Healthcare providers and pathology laboratories will no longer be restricted from viewing your screening record online.

Provided your given name(s) and family name, as recorded with Medicare

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

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

View the privacy policy

  • I acknowledge that I (including my personal representative or nominated healthcare provider, if I have one) will receive correspondence, sent from the NCSR for the bowel or cervical screening program to my legal name as recorded with Medicare.
  • My personal information and screening details will be recorded under my legal name on the NCSR.
  • I may request for a pseudonym at any time by completing a Request to Nominate a Pseudonym webform, or by calling the Contact Centre on 1800 627 701.
  • I acknowledge that I am making a formal request to withdraw a pseudonym in accordance with section 14 of the National Cancer Screening Register Act 2016, and under Australian Privacy Principle 2 relating to anonymity and pseudonymity.
  • I acknowledge that my selected request(s) will be actioned.
  • I declare that I am the participant or their authorised personal representative.
Acceptance of terms *