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Request to cancel or defer surgery

This form is for cancelling or requesting a change to your planned operation at one of our hospitals only.

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

Your details

NHS number

Full name*

Address*

Date of birth (DD/MM/YY)*

Telephone (home)*

Telephone (mobile)

Email*

Consultant name if known

Department

Reason for cancellation/deferral request*

If other, please specifiy why:

Email 2*:

* required fields

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

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Royal College of Nursing members at our Trust are taking part in strike action Monday 6 and Tuesday 7 February from 7.00am to 8.00pm. This will impact services at our hospitals.

If you are due to attend an appointment and we haven't already contacted you, please come as planned.

On days where there is strike action, patients should only call 999 if it is a medical or mental health emergency (when someone is seriously ill or injured and their life is at risk).