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Smear Test Request

Please only complete this form if you have received a request for your smear test. Please let know know a preferred date/time for your smear test.

Information about the smear test can be found on the Cervical Screening Guide on

Smear Test Request
Enter Email
Confirm Email
Please use format day/month/year e.g. 12/05/1979
Where would you prefer to have the test

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.