Cervical screening programme (deferral)

NHS Number (if known):

Home Full Address:

Please defer until: *

Please use date format DD/MM/YYYY (maximum 18 months deferral)

Deferral reason: *

Recent test

Currently pregnant

Under treatment relevant to screening

Under the care of colposcopy

Patient’s request to defer

Please provide a copy of your recent test results to the practice.

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