Book Cervical Smear Appt

To make an appointment for a cervical smear test, please complete the Form below and our Administration Team will contact you to tailor an appointment to your personal requirements. Waiting time for an appointment is usually one week. NOTE Smear Tests can only be carried out before or after your period. br/>
CERVICAL SCREENING IS CARRIED OUT TUESDAY WEDNESDAY & THURSDAY MORNINGS , MAY REQUIRE UP TO 30 MINUTES & IS CHARGED AT €225.00

THANK YOU
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Birth
Date Format: MM slash DD slash YYYY
Email*
Phone*
GP Name
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
GP Email Address*
When was your last Cervical Smear ?
What was the result / Outcome ?
Are you*
Do you have any children?*
Brief Summary of your Medical History and (if any)Pregnancy History
Contact Permission
I Agree to be contacted by phone & email in relation to this enquiry*
- YES
Patient Database Protection Permission Agreement
To facilitate your patient care, we need your permission to contact you and any other medical service providers agreed with you, during the course of your treatment, by email, SMS, phone and other electronic means. We'll always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes. All personal data which is emailed, is encrypted, password protected & GDPR compliant
Date
Date Format: MM slash DD slash YYYY
Cervical Screening Appointment - Price
Price: 225,00 €
Total
0,00 €
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Contact Permission

Patient Database Protection Permission Agreement