Get Colposcopy Referral Form - Cervical Check

This guide provides clear and supportive instructions for users on effectively completing the Colposcopy Referral Form - Cervical Check online. Following these steps will help ensure that you submit the necessary information accurately and efficiently.

Follow the steps to complete the Colposcopy Referral Form online.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Begin by providing the patient details, including their surname, first name, date of birth, address, and telephone numbers. Ensure that you fill in all required fields marked appropriately.
3. Next, enter the referring general practitioner details. This includes the GP's surname, first name, mobile, and landline information.
4. Indicate whether the patient consents to receive a text reminder for their appointment, and specify their first language.
5. In the referral information section, select the reason for referral by checking the appropriate box—this could be due to an abnormal cervical screening test or a suspicious cervix.
6. Fill out the details of the cervical screening test, including the date, result, accession number, and reporting laboratory. Remember to attach a copy of the cervical screening test report with the referral.
7. Provide additional information regarding the patient's previous cervical screening tests, medical and surgical history, and any previous treatments or colposcopies.
8. Indicate any current medications, allergies, and smoking status to provide the colposcopy service with comprehensive patient background.
9. Finally, ensure all fields are accurately completed and review the form before saving your changes. You can then download, print, or share the completed form as required.

Take action now by filling out and submitting the Colposcopy Referral Form online.