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

Update for visitors

Visiting restrictions are in place at our hospitals to stop the spread of norovirus. These restrictions will be in place until further notice.

The following wards are closed to visitors:

York Hospital: Ward 29 and Ward 37.

There are four exceptions only to the restrictions. These are:

For patients who are receiving end of life care

Paediatric patients (babies and children)

Maternity care

The family carers of those with dementia

We understand these restrictions can be difficult when a loved one is unwell. The restrictions will be reviewed daily and lifted as soon as it is safe. Thank you for your understanding as we try to reduce the spread of norovirus in our hospitals.