Screening attendance

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We are requesting you complete this form to better understand why some of our patients have not responded to their invitation to attend a routine smear screen.

We want to support you as best we can to attend and be completing this form, you are helping us to understand why some do not respond to the invite and to support us to develop our cervical screening offer.

This should not take anymore than 2 minutes to complete.

What time of day would be best for you:: *

How can we support you with this?: *

Can we send you some information relating to the benefits of screening?: *

You may also like to read information available on our website…insert link..

Optional

Would you be willing to have a preliminary appointment with a nurse to discuss the procedure to see if they will reconsider in the future: *

Can we send you some information relating to this?: *

You may also like to read information available on our website…insert link...

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Personal Details

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Would you be happy for us to contact you as a result of this forms submission? We may be able to provide you with a more personalised approach to supporting your attendance/see if we can do anything to help you attend/seek the assurances you need?: *

Privacy Consent

This form collects personal and medical informanot tion 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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Screening attendance

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