I acknowledge that:•by completing and returning this form and/or the test to the pathology laboratory I am agreeing to become a participant in the National Bowel Cancer Screening Program; •by agreeing to participate in the National Bowel Cancer Screening Program I agree to being invited again in the future to complete tests during the period I am eligible to participate except during any time I opt out or defer my participation; •the Doctor/Medical Practice listed in Section A of this form will be sent a copy of my test result and that I can call the National Bowel Cancer Screening Program Information Line on 1800 118 868 (freecall) if I want to change this to a different Doctor/Medical Practice; •I may opt out or defer my participation in the Program at any time by completing the opt out or defer advice notice available on www.ncsr.gov.au or by phoning the National Cancer Screening Register Contact Centre on 1800 118 868 (free call); •I have read, or had explained to me, and understand the National Bowel Cancer Screening Program Information Booklet, the Your Privacy section of this form and the test instructions; and •the test samples I have provided will be tested for the presence of blood, and I understand that: ◦screening tests are not always 100% accurate and therefore test results cannot be guaranteed (studies indicate that these tests detect 60–85% of cancers); and ◦if blood is found in the sample provided it is my responsibility to contact a doctor to discuss the results, the nature and risks of any further tests and to arrange for further tests following a full clinical assessment. It is not the responsibility of the Program or its employees, agents or anyone connected with this test procedure to do this for me.AND•I consent to the National Cancer Screening Register collecting sensitive information such as information about my health and racial or ethnic origin for the purpose indicated in Section B9 of this form. •I also agree for my address to be updated as per the address provided in Section A of this form.•If I have nominated a personal representative to act on my behalf in Section B8, I agree to the the NCSR contacting this person to confirm my nomination and if required to seek further legal documentation.