Cancel Your Appointment

Please let us know as soon as possible if you are unable to make your appointment by completing the form below. THIS FORM SHOULD ONLY BE USED IF YOUR APPOINTMENT HAS BEEN SET FOR MORE THAN 24 HOURS IN ADVANCE. If your appointment has been arranged for a time within the next 24 hours, please call Reception directly on 01202 897989 for our Corbin Avenue surgery or 01202 874302 for our Glenmoor Road branch.

Your Details

Name *

Date of Birth (DD/MM/YYYY) *

Phone Number

Email Address *

Postcode *

Appointment Details

Appointment Type *

Name of Doctor or Nurse

Appointment Date *

Appointment Time *

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

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The information you provide on this form will be sent to our practice and used only to deal with your request. Depending on the form, this may include your contact details, personal information and health information. The practice may add it to your medical record and, where needed for your care, share it with other NHS and care services. To find out how we protect and use your information, please read our privacy policy on our website.

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Page last reviewed: 07 April 2023
Page created: 14 October 2026

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Cancel Your Appointment

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