Background With resource limitations and increasing burden of colorectal cancer, patient-initiated follow-up (PIFU) has been introduced in some centres internationally. Patients continue regular surveillance investigations, however, instead of scheduled visits, patients can make contact if they develop any symptoms, with a follow-up visit arranged if required. The aim was to utilise the patient voice and current evidence to develop a patient-initiated follow-up protocol in colorectal cancer after curative-intent surgery in Northland. Methods A qualitative synthesis was performed using results from an interview-based study of 13 colorectal cancer patients in Northland, an audit of current follow-up in Northland and the current literature. Consultation was undertaken with the multidisciplinary colorectal department in Northland. Results Patient selection into PIFU facilitates patient choice. PIFU consists of three components: empower, educate and express. Empower: Patients can tailor their follow-up by organising appointments as needed, choosing the frequency and modality, whether its telephone or face-to-face. Educate: The patient education booklet provides the surveillance plan, managing physical and psychosocial symptoms, dietary advice, and contacts for extra support. Express: Contact details are provided for the nurse specialist and stoma nurse, along with information on symptoms to prompt contact. Conclusion The PIFU protocol for Northland is an evidence-based pathway, utilising the patient voice in its development and facilitating patient choice in follow-up after colorectal cancer surgery. The next step is to trial this protocol using a randomised controlled trial to ensure patient satisfaction and oncological safety.