Forms : The Leeds Teaching Hospital

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Cancelling an appointment

Online Cancellation Form

Please complete the form below to notify us of your cancellation request, please note that all fields are mandatory and have to be completed to submit this form.

Your details

NHS Number *

Full Name *

Address *

Date of Birth *

Telephone (home) *

Telephone (mobile) *

Religion *

Ethnic group *

Marital status *

GP *

Your existing appointment

Date of appointment *

Time of appointment *

Department *

Consultant name *

Reason for the cancellation *

Re-booking your appointment

Would you like to re-book another appointment? *

YES

Appropriate date for your next appointment *

State a suitable time to contact you *

Our reminder service

We shall soon be launching a reminder service by text to your mobile or voice mail to your land line.

Please state whether you would like a text reminder service? *

YES

Please enter the verification code below *

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Leeds Teaching Hospitals NHS Trust