HPV self-test request form

At-home HPV test request form

The free at-home HPV test is only available for people who are eligible for free cervical screening in Aotearoa New Zealand.

The following questions will help us check if you’re eligible. Once you submit the form, we'll process your request and check your cervical screening history and eligibility. We'll send you an email if your tests have been ordered. Or we’ll email you to let you know if you need to go to a clinic to pick up an HPV test or do a cervical sample in person.

Do you have a cervix?

Yes
No

Are you immune deficient or taking immunosuppressants?

Yes
No

Normally you only need to do cervical screening if you have a cervix. If you used to have a cervix but you’ve had a hysterectomy, you probably don't need screening. But if you have questions about this, make an appointment with us or your usual doctor.

Do you have a Community Services card?

Yes
No

What ethnicity or ethnicities do you identify with? (Choose as many as you need)

New Zealand Māori
New Zealand European
Samoan
Cook Island Māori
Tongan
Niuean
Chinese
Indian
Other

Other ethnicity or ethnicities

If you identify as Māori, please tell us your iwi affiliation.

Have you had cervical screening before?

Yes
No

We need to look up your cervical screening history. Do you give your consent for us to check your cervical screening history?

Yes
No

Sorry, to use this service you must consent to us looking at your cervical screening history. If you don’t want to do this online, there are other cervical screening options.

Don't have a shop account?

HPV self-test request form

Share this page

At-home HPV test request form

Share this page