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

Industrial action: 14 - 19 November

The British Medical Association has announced that resident doctors in England will stage industrial action from 7am on 14 November to 7am on 19 November.

During this time, some of our services may be affected. We will contact you directly if your appointment needs to be changed. Otherwise, please attend your appointment as planned.