Cervical Screening Pre-appointment Assessment

Please complete this form prior to your cervical screening (smear test) appointment.

Cervical Screening Pre-appointment Assessment

Section

Please use date format: DD/MM/YYYY
Are you experiencing any unusual discharge? *
Are you experiencing any bleeding after sex? *
Are you experiencing any bleeding between periods? *
Are you experiencing any bleeding after the menopause? *
Do you have a coil inserted for contraception? *
Are you on HRT? *