Decline an Annual Health Review/Assessment or Vaccination

Please do not send me any further invitations to have a Cancer Care review. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have an Atrial Fibrillation review or to offer medication. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have an Asthma review. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have an Alcohol Consumption review. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to record my BMI. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Blood Pressure review. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Coronary Heart Disease review. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a COPD review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Depression review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Diabetes review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Heart Failure review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Hypertension review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Mental Health review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Non-Diabetic Hyperglycaemia review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Rheumatoid Arthritis review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Smoking review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Stroke/TIA review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a vaccination this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Please do not send me any further invitations to have a Medication Review this year. I assume full responsibility for this decision, and I understand that I can contact the practice to reinstate it or speak to a clinician at any time.

Women aged 25 to 49 years of age are invited for cervical screening every three years, and women age 50 to 64 years are invited every five years. The risk of developing cervical cancer can be significantly reduced by having regular screening.

If you do not want to be called for future cervical smears, please complete this form and the practice will send you instructions regarding how to submit a NHS Cervical Screening Programme Decline. By declining, you will not receive any further invitations to be screened for cervical cancer or any further information about the NHS Cervical Screening Programme.