Pre Prostate Screening Questionnaire.  The screening will include a blood test and a Digital Rectal Examination (DRE)

Request to be offered a screening  appointment on Saturday 5th September 2026 at Eaton Socon Health Centre 274 Great North Road St Neots PE19 8BB

The screening will include a blood test and a Digital Rectal Examination (DRE)

Note 1: The below information is required by and will only be passed to the NHS Consultant when arranging appointments and will otherwise be kept confidential.

Note 2: You will be required to have with you information about your medical history and list of medication on the day of the test if offered an appointment.

Note 3: To protect your privacy, you may be asked to show a passport, driving licence or some other proof of identity.

Note 4: You can obtain your NHS number from your GP.

Note 5: You will be contacted to confirm a time slot that is convenient for you.

Note 6: There are a limited number of slots available for this event.

Note 7: You Must Not Be Suffering from any other Form of Cancer.

Note 8: Please let us know if you cant attend ASAP

Note 9: Contact Number Dave young 07855575622

Privacy Notice: By submitting this form, you consent to your personal information being collected for the sole purpose of arranging your prostate cancer screening appointment on Saturday 5 September 2026. Your information will be used only by the event administration team and shared with the NHS clinical team delivering the screening so they can assess your eligibility and contact you to book your appointment. Your data will be stored securely, will not be used for marketing or shared with any other organisation without your consent unless required by law, and will be securely deleted when it is no longer needed for the administration of this screening event.

Consent Statement.

“The information you provide will only be used to administer your prostate cancer screening appointment and to support the clinical team delivering the event. Your personal information will be handled securely in accordance with UK data protection law and will not be used for marketing or shared with third parties except where necessary for your clinical care.”


Important: The PSA test has both benefits and limitations. By registering, you confirm you have read the NHS information about the PSA test and understand you can discuss any questions with the clinical team before testing.


 
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Full Name *
Date of Birth *
MM
/
DD
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YYYY
NHS Number *
Home Address  *
Postcode *
Best Contact Number *
Email Address *
GP Surgery Name  *
GP Address *
Do you agree to a  Digital Rectal Examination (DRE) If you answer No you cant be registered at this event I'm afraid  *
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