Cancellations 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

Your existing appointment

Re-booking your appointment

Would you like to re-book another appointment? *

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? *

Human verification

To combat spam and ensure only valid details are provided please enter the verification code below


Leeds Teaching Hospitals NHS Trust