Appointment cancellation form

This form is for cancelling an appointment at one of our hospitals only.

Please complete the form below to notify us of your cancellation request.

If your appointment is today, please call the Contact Centre on 01904 726400.

Your details

NHS number

Full name*

Address*

Date of birth (DD/MM/YY)*

Telephone (home)*

Telephone (mobile)

Would you like to receive text reminders of your appointment*

Your existing appointment

Date of appointment (DD/MM/YY)*

Hospital*

Time of appointment*

Consultant name

Department

Reason for the cancellation*

If other, please specify why:

Re-booking your appointment

Would you like to re-book another appointment?*

* required fields

Resident doctor strike action

Resident doctors will be taking strike action from 7am on 17 December to 7am on 22 December. Some appointments and procedures may be affected. If your appointment needs to be changed, we will contact you.

If you've not heard from us, please attend your appointment as planned.

Please continue to come forward for care, particularly in an emergency or life-threatening situation. Use NHS 111 to find the most appropriate service for your needs.