Need to change or cancel your outpatient appointment?

If you have been given an outpatient appointment at the hospitals and unable to attend or need to change it for whatever reason you can use the form below.

It is really important that you let us know of any changes as soon as possible. This means we can offer the original appointment to another patient and provide you with another date as quickly as we can.

Please complete the form below with your contact details and as much information as possible. You can find most of the information we need on your appointment letter.

If you have any problems using this form, please call the number on your appointment letter and we will do our best to help you. You will receive a response from us so you know it has been received and actioned.

1. Your details
Forename*
Surname*
Date of Birth* (DD/MM/YYYY)
NHS Number (if known)
Address
Postcode*
Email*
Phone*
2. Your appointment
Hospital unit number (you can find this on your appointment letter)
Appointment Date (DD/MM/YYYY)
Clinic / Specialty*
Site
3. Your request
Request*	Change Appointment (We will contact you with another appointment) Cancel Appointment (You will not be given a further appointment)
Message	Please inform us of any future dates/times where you are unable to attend and we will do our best to accommodate these if rescheduling your appointment
Why you need to change/cancel your appointment	Please tell us why you need to change your appointment by selecting a reason below: I am ill I am on holiday I am busy I no longer require an appointment I intend to go private Other
I understand that the information I have entered will be sent via email to the Trust Appointments Team. I am happy for the team to reply by either phone, post or email as per the information supplied on this form.