NHS cervical screening programme decline

Section

Address (including postcode): *

Date letter received: *

Please use date format: DD/MM/YYYY

*

I have read the information in your letter and the information on the on the Jo’s Trust Website and understand the risk of not taking part in the NHS Cervical Screening Programme. I am making an informed decision to opt out of NHS Cervical Screening Programme. I understand that I can opt in at any time by contacting the surgery.

Signature: *

Date:

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NHS cervical screening programme decline

Section