Requesting an Appointment for a Cervical Screening

Requesting a Cervical Screening Appointment

Please complete this form if you would like to book or request a cervical screening (smear test) appointment. A member of our team will review your request and send a booking link.

Name  Required
Date of Birth  Required
Address  Required

Screening Details

Have you received an NHS invitation letter for your cervical screening?  Required
Date of your last cervical screening (if known):  Optional
Where was your last screening done?  Required

Eligibility and Medical Information

Are you currently menstruating (on your period)?  Required
Have you had a hysterectomy?  Required
Are you pregnant or have you given birth in the last 3 months?  Required

Additional Information

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