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Informed consent for withdrawal from the cervical screening programme

Use this service if you wish to permanently withdraw from the NHS cervical screening programme.

To remove your name from the list of participants invited for cervical screening, you need to fill in and submit this form to confirm that you do not wish to receive any future invitations from the NHS cervical screening programme.

You can use this service if you:

  • are registered at the surgery

Please read the leaflet ‘NHS cervical screening: helping you decide (PDF)’ that explains the benefits and disadvantages of cervical screening and the importance of screening in reducing deaths from cervical cancer. The risk of developing cervical cancer can be significantly reduced by having regular screening. If you need further information, please do not hesitate to contact your GP.

CSAS will send you written confirmation when your name has been removed from the screening list. If you change your mind, please contact your GP who can ask for your name to be put back on the screening list.

Before you start

We’ll ask you for:

  • your first and last name, date of birth, sex, postcode, email and phone number
  • if applicable, the details of the person you are completing the form on behalf of

Next steps

Once you have filled this form in, please submit it to your GP who will keep a copy in your medical record and send a copy to CSAS or you can submit the form directly via CSAS home page and select ‘self cease’ option.

If you have not received written confirmation that CSAS have received your form within 2 weeks, then please contact your GP.

Start now

You can also phone us on Kidlington Health Centre 01865 842 292 or Yarnton Surgery 01865 379 345.