Appointment Cancellation By Email

Please use this form to cancel an appointment.

Name*
First Last
Date of birth*
MM slash DD slash YYYY
Patient NHS Number (if known)
Appointment with*
Appointment date*
DD slash MM slash YYYY
Appointment time*
: Hours
Minutes
Email address
Enter Email Confirm Email
Contact Telephone Number*
Consent*
I agree to the privacy policy.
Please note that no medical information or questions will be responded to. The data you supply on this form will be stored on our website, which is hosted by a third party, until it has been processed by the practice. The data will be used lawfully, in accordance with the Data Protection Act 2018, which gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly. The practice privacy policy can be viewed on this website.