Support for submitting Cease/Reinstate/Defer/Gender Opt-In form templates 

To securely send Patient Identifiable Data, please complete the appropriate form and document template

Once you submit your form you will receive a confirmation email. Please allow up to 10 working days for a response

Download and edit the form template document

These documents are locked and allow specific fields only to be edited to ensure they remain standardised across the service.  Please ensure that you clear your internet cookies and cached images and files in order that you download the latest version of the file before clicking on the relevant link. If you are unsure how to do this please contact your IT department

• Ceasing from the Cervical Screening Programme
• Ceasing from the Cervical Screening Programme – Mental Capacity Act (MCA)
• Informed Consent for withdrawal from the Cervical Screening Programme – This form should be completed once the ”Helping you decide”  leaflet has been read by the patient and they still wish to withdraw from the programme
• Reinstate into Cervical Screening Programme
• Cervical Screening Programme Deferral
• Gender Opt-In

Select the appropriate form document template from the list by clicking on the link then downloading and opening the document

Click “Enable Editing” at the top of the document highlighted in yellow

Type required details onto the forms in the editable spaces

Where a wet signature is required, please print off the form and once signed, scan the form and save it. Where an electronic signature is permitted, complete the form electronically and save it

Upload to the online form as an attachment

Go to the appropriate online form for your request on the website:

Complete the mandatory fields for your request, then upload the relevant completed document

Submit the online form request

Submit the request once you have completed all the relevant information and uploaded the document