Cancel a booked Appointment – Dunsville Medical Centre

If you are not registered for the Online System, please use the form below to cancel a booked appointment or call the surgery direct.

Appointment Cancellation

Thank You for letting us know you can't attend an appointment. If you need to cancel an appointment within the next 2 hours please call the surgery direct 01302 890108. If you wish to cancel a later appointment you can complete this form, with the option to request a call-back to rebook.

Name*
First Last
Please enter Patients Full Name
Date of Birth*
DD slash MM slash YYYY

Please enter Patients Date of Birth
Postcode*
Please provide Patients Postcode
Appointment Date*
DD slash MM slash YYYY

Please provide the Date of the Appointment you wish to cancel
Appointment Time*
: Hours
Minutes
AM/PM
Please provide the time of the Appointment you wish to cancel
Patient Confirmation*
- I confirm I am the Patient
- I am the Patients Authorised Representative
Please confirm you are the patient, or if patients representative please provide your name below
Name of Patient Authorised Representative
If you are authorised by the patient to take this action, please confirm your name. Please note if your authority is not recorded on the patients record we may contact you or the patient.
Phone*
Please provide a phone number in case we need to call you back.
Rebook Appointment?*
Please indicate if you would like a call back to rebook the appointment at a later date.

Appointment Cancellation

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