Freephone information line: 1800 45 45 55

Forms, reference documents and reports

Forms, reference documents and reports for use in the CervicalCheck cervical screening programme.

Forms for GP practices and clinics

Cervical Screening Form (consent form)

  1. Cervical Screening Form (CS/F/LAB-2 Rev 17)
  2. Information Sheet which includes information about informed consent - this consent form includes an information sheet so that a person can make informed consent

How to complete the cervical screening form (by setting)

  1. How to complete the cervical screening form for GP practices
  2. How to complete the cervical screening form for Clinics in primary care (CLIN)
  3. How to complete the cervical screening form for Public primary care clinics (PPCC)
  4. How to complete the cervical screening form for Gynaecology clinics (GYN)
  5. How to complete the cervical screening form for STI/GUM clinics (STI)
  6. How to complete the cervical screening form for Oncology clinics (ONC)

Colposcopy Referral Form

Colposcopy referral form (PDF, 1 page, 308KB) -use this form when making a referral to colposcopy


Hysterectomy data collection form (PDF, 1 page, 200KB) - for women who have had total abdominal hysterectomies and do not need future cervical screening

Cervical Screening Not Advised

Cervical screening not advised (PDF, 1 page, 120KB) - for when a person no longer needs to be called for regular cervical screening

Guidance notes

You can find guidance notes for cervical screening sample takers here.

Cervical screening test

  1. Eligibility framework for cervical screening (PDF, 1 page, 150KB) - reference guide for GPs and sample takers to check if a person is eligible for a screening test
  2. HPV Primary Screening Algorithm (PDF, 1 page, 115KB) - description of referral pathways
  3. Desktop guide - information sheet to support doctors and nurses with HPV cervical screening (You will need login details for National Screening Services Resources website to access this document)

Results recommendation guidance

  1. Cervical screening results and recommendation table (PDF) - describes the management recommendations provided by the pathology laboratory
  2. Cervical screening results and management recommendations guide (PDF, 10 page, 450KB) - comprehensive guide on the management recommendations of a person based on their results.
  3. Cytology Terminology Table (PDF, 1 page, 220KB) - Recommendations for management of person based on their screening test results

Colposcopy algorithms

  1. Colposcopy Algorithm 1 Management of people with HR-HPV positive & normal or low grade abnormal cytology
  2. Colposcopy Algorithm 2 Management of people with HR-HPV positive and high grade abnormal cytology or any glandular abnormality (including Atypical Glandular Cells)
  3. Colposcopy Algorithm 3 Colposcopy Management of people for Test of Cure following treatment of CIN
  4. Colposcopy Algorithm 4 Colposcopy Management of people for Test of Cure following complete excision of CGIN/SMILE
  5. Colposcopy Algorithm 5 Conservative Management of histologically confirmed CIN 2

Sample multilingual CervicalCheck information sheets and screening forms - for participants and healthcare professionals

The links below lead to translations of the sample CervicalCheck Information Sheet and Cervical Screening Form. These documents are to aid you in explaining what cervical screening is to participants where English is not their first language. However, you must use the English screening form when you are submitting the screening sample.

If you would like to suggest a language the forms should be translated into, please email

HPV cervical screening newsletter

CervicalCheck programme reports

Multilingual CervicalCheck information videos - for participants and healthcare professionals

CervicalCheck - HPV cervical screening - English

Rastreio cervical / HPV cervical screening - Portuguese

Badania przesiewowe szyjki / HPV cervical screening - Polish

حص عنق الرحم فحص / HPV cervical screening - Arabic

Testul de evaluare cervicală HPV / HPV cervical screening - Romanian

La Prueba de Detección del VPH en el Cuello Uterino / HPV cervical screening - Spanish

Скрининг шейки матки / HPV cervical screening - Russian

Le frottis cervical de dépistage / HPV cervical screening - French

رویکل اسکر سرویکل / HPV cervical screening - Urdu

HPV gimdos kaklelio patikrinimo testą / HPV cervical screening - Lithuanian

Dzemdes Kakla Skrīnings / HPV cervical screening - Latvian

Cervikálny skríning, na HPV / HPV cervical screening - Slovak

Àlàyé nípa síṣe àyèwò akàn ilé-ọmọ fún kòkòrò HPV / HPV Cervical Screening - Yoruba

Taarifa kuhusu upimaji wa virusi vya HPV kwenye shingo ya uzazi / HPV Cervical Screening - Swahili


Informacija o probiru HPV-a vrata maternice / HPV Cervical Screening - Croatian

Macluumadka Baaritaanka Ilmo- galaynka ee HPV / HPV Cervical Screening - Somali

HPV 宫颈筛查信息 / HPV Cervical Screening - Mandarin

ا بچہ دانے د خولے ٹیسٹ / HPV Cervical Screening in Pashto

সার্ভিকাল ক্যান্সারের স্ক্রিনিং বিষয়ে / HPV Cervical Screening in Bengali


Is cuid den tSeirbhís Náisiúnta Scagthástála é CervicalCheck
Bosca Oifig Phoist 161, Luimneach
Saorghlao 1800 45 45 55
CervicalCheck is part of the National Cancer Screening Service
PO Box 161 Limerick
Freephone 1800 45 45 55

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Is cuid den Rannóg Sláinte agus Folláine i bhFeidhmeannacht na Seirbhíse Sláinte í an tSeirbhís Náisiúnta Scagthástála. Cuimsíonn sí BreastCheck – An Clár Náisiúnta Scagthástála Cíoch, CervicalCheck – An Clár Náisiúnta Scagthástála Ceirbheacs, BowelScreen – An Clár Náisiúnta Scagthástála Putóige agus Diabetic RetinaScreen – An Clár Náisiúnta Scagthástála Reitiní do Dhiaibéitigh.

The National Screening Service is part of the Health and Wellbeing Division of the Health Service Executive. It encompasses BreastCheck – The National Breast Screening Programme, CervicalCheck – The National Cervical Screening Programme, BowelScreen – The National Bowel Screening Programme and Diabetic RetinaScreen – The National Diabetic Retinal Screening Programme.