Cancel Appointment

If you want to cancel an appointment that is more than 24 hours away, please let us know as soon as possible by completing the form below.

If your appointment is within the next 24 hours, please call the surgery to ensure we can free up the appointment as emails may not read immediately.

First Name

Last Name

Date of Birth (dd/mm/yyyy)

Phone

Full Address

Appointment Date

Appointment Time

Appointment Type (eg. GP, bloods, childhood vaccines)

I confirm that I will not be attending this appointment.

Do you wish to reschedule this appointment?

Yes

Desired Appointment Date

Desired Appointment Time

I understand that my desired appointment date/time may not be available and that the practice may offer an alterative date/time.

I consent to this message being sent over the internet to the practice. I have checked that the email address and phone number I have given are correct and I consent to receiving medical information via email or text.

By submitting this form you will be sending personal/sensitive information about yourself across the Internet. Please read our privacy statement to read how we protect and manage your submitted information. We make every effort to keep this information secure, however you should be aware that we cannot guarantee privacy over the internet. If this concerns you, you should contact the practice by phone or in person.

Cancel Appointment

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