Nurse Cervical Screening Provider Certification Form

Please complete this form to apply for Nurse Cervical Screening Provider Certification through Cancer Council Victoria.


Personal information








Employment information













Declaration

I consent for Cancer Council Victoria to forward the information in this form to VCS Pathology and for my data to be shared between Cancer Council Victoria and VCS Pathology? This is a required field.
(VCS Pathology will issue a unique ‘practice number’ via email. This practice number enables you to submit your cervical screens to be processed.) 




To update your details

To update your details, add practice locations or for more information, please email certification@cancervic.org.au or call 1800 111 255.

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