Book a Smear Appointment

Please complete the form

Make an Appointment

Request an Appointment Online

Smear Appointment Form

Required fields are marked with an asterisk (*).

This pathway is only for SMEAR appointments, any other submissions will not be actioned.

SMEAR appointments are invitation only, you could have been invited by SMS, Phone call, Letter or a message on the NHS app.

Please note, SMEAR appointments are always with a Female Practice Nurse, and appointments may fall on a Saturday.

Name

First

Last

Date of Birth*

Email address*

Phone Number*

NHS Number

Please provide the following information below to allow us to action your request –

Date of last SMEAR appointment?*

Are you currently pregnant or given birth in the last 12 months?*

Yes

Have you had any form of Hysterectomy?*

Yes

Sex at birth*

Male

Female

Preferred day or time of appointment? We will aim to fulfil your request, but this may not always be possible

Privacy Consent – This form collects personal and medical information about you/ We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage submitted data.

I consent to the practice collecting and storing my data from this form

Are you human?*

This field should be left blank

Other forms available

Register as Patient

Please visit our Patient Registration page and fill in the health questionnaire to register as a patient at Teldoc.

Change of Contact Details

If you need to update your email or contact number, then please use this form

Contraceptive Review

Visit here for contraceptive review forms and services

More Self-Referral and Review Forms

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More forms

Please visit the How Do I Portal for more forms

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Visit the How Do I portal for information on how to make an appointment, register at the practice and change your details

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01952 460 414

Haughton Road, Shifnal, Shropshire, TF11 8DD

Gatcombe Way, Priorslee, Telford, TF2 9GZ

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