Form online 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section A, entering patient details such as Family Name, Given Names, and Date of Birth. Ensure all fields are filled in BLOCK LETTERS.
3. Next, provide the colposcopist's information including Provider Number and Clinic Name. This section is crucial for identifying the healthcare provider.
4. Move to Section B and select the primary indication for colposcopy. Choose one option that best describes the reason for the procedure.
5. Complete Section C if treatment was performed. Specify the excision type and modality used for excision, ensuring accuracy in your selections.
6. Review all sections for completeness before submitting. Remember to keep a copy of your completed form for your records.

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