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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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ADVICE FOR PATIENTS AND VISITORS

Due to the rate of COVID infection rising in the hospital and community, patients and visitors are required to wear a surgical mask or face covering from entering trust premises. Masks and hand hygiene facilities are available at the entrances