Smear Cessation Form



Cervical screening is very important in preventing cancer.

Please see

If you really don’t want it please download the smear cessation form, fill It and return it to us.

smear cessation


Informed​​ consent​​ for​​ withdrawal​​ from​​ the​​ Cervical​​ Screening​​ Programme


This form should be used only if you wish to permanently withdraw from the NHS Cervical Screening Programme.


To​​ remove​​ your​​ name​​ from​​ the​​ list​​ of​​ women​​ invited​​ for​​ cervical​​ screening,​​ you​​ need​​ to​​ sign​​ and​​ return​​ this​​ form​​ to​​ confirm that​​ you​​ do not wish​​ to​​ receive any future invitations or any further information about the​​ NHS​​ Cervical Screening​​ Programme.


If​​ you​​ wish​​ only​​ to​​ delay​​ your​​ next​​ cervical​​ screening​​ test,​​ then​​ do​​ NOT​​ use​​ this​​ form.​​ You​​ can​​ delay​​ your​​ next​​ test​​ by contacting​​ your​​ General​​ Practitioner​​ (GP)​​ who​​ will​​ be​​ able​​ to​​ advise​​ you.


Please​​ read​​ the​​ leaflet​​ ‘NHS​​ cervical​​ screening:​​ helping​​ you​​ decide’​​ 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​​ after​​ you​​ have​​ sent​​ this​​ form​​ to​​ the NHS Cervical Screening Administration Service (CSAS),​​ please​​ contact​​ your​​ GP​​ who​​ can​​ ask​​ for​​ your​​ name​​ to​​ be​​ put​​ back​​ on​​ the​​ screening​​ list.



Please do not send me any further invitations to participate in the NHS Cervical Screening Programme. I assume full responsibility for this decision and confirm that I have understood the leaflet on cervical screening which explains the benefits and disadvantages of cervical screening and the importance of screening in preventing cervical cancer and reducing deaths from it.


I understand that my name can be restored to the screening list at any time at my request to my General Practitioner














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Next Steps

We recommend you keep a copy of this form (e.g. photocopy or photograph).


Please give this form to your GP who will keep a copy in your medical record and send a copy to us.


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


Next steps for Practices: Once completed and signed, please upload this FORM via the​​ CSAS​​ website. You should use the online enquiry form on the ‘Contact Us’ page and select the ‘Cease’ option. Keep the original copy in your files.


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