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Contact us

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 recieve text reminders of your appointment*

Email

Your existing appointment

Date of appointment (DD/MM/YY)*

Time of appointment*

Consultant name

Department

Reason for the cancellation*

If other, please specifiy why:

Re-booking your appointment

Would you like to re-book another appointment?*

Email 2*:

* required fields

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