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Your visit

Cancel your appointment

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*


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)*


Time of appointment*

Consultant name


Reason for the cancellation*

If other, please specify why:

Re-booking your appointment

Would you like to re-book another appointment?*

Email 2*:

* required fields

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