Cervical Smear Deferral

This form should be used if your next test is to be postponed. The reason for postponement and new deferral date must be specified.

You will be invited for screening approximately 5-6 weeks before the end of the deferral period.

If you are human, leave this field blank.

NHS Number (if known):

Home Full Address:

Please defer until: *

Please use date format DD/MM/YYYY (maximum 18 months deferral)

Deferral reason: *

Recent test

Currently pregnant

Under treatment relevant to screening

Under the care of colposcopy

Patient's request to defer

If applicable, please provide a copy of your recent test results:

Maximum upload size: 67.11MB

I confirm that I am a patient at Grovelands and Grenoble Medical Centre, London.

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