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Cervical Screening

Please help us to help our patients by better understanding the reason for not attending their smear test.

Our patients long-term health is very important to us, so any information you provide that will help us to help our patients get the screening they deserve (and live long and healthy lifestyles!) will be gratefully appreciated.

Your answers are completely anonymous - unless you would like to provide your name and date of birth so that we can personally support you in getting your test completed.

Our nursing team are amazing and if you do opt for some support they will call you personally to discuss.

Alternatively you can opt out for a short period or request we don't invite you again.

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All questions marked with a * are mandatory

Please choose the most appropriate option to continue: *

You must select a date within the next 18 months

You are unable to continue with this form: *
Questionnaire
When I get my invite to book for a smear test: *
When I attend for a smear test: *
How I feel about the potential smear test results: *
Would you like to speak to a nurse about booking my smear test: *
I am happy for admin to call me to book my smear test: *
I would prefer to be sent a link to book online for my smear test: *
I would like to be sent a link to where I can find out more information about cervical screening: *
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Anonymity
Would you like to remain anonymous: *
Personal Details

Your responses require us to update your records or contact you so we need to ask for some personal information.

This is optional and you can remain anonymous.
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Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Company Registration Number: 06975947

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Registered office: 1 Christchurch House Beaufort Court, Sir Thomas Longley Road, Rochester, Kent, England, ME2 4FX

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