Cancel appointment - Church Surgery

Cancel an Appointment

Please let us know as soon as possible if you are unable to make your appointment by completing the form below.

If your scheduled appointment is within the next hour, please call us to inform us so that we can allocate the appointment to another patient.

If your appointment is more than 1 hour away, please complete the form below

Many thanks

If your scheduled appointment is within an hour please call us to cancel the appointment so that we can allocate the appointment to another patent.

Name

Date of Birth

Phone Number

Email Address

Postcode

Appointment Type

Appointment Date

Appointment Time

Who is the appointment with?

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

I consent to the practice collecting and storing my data from this form.

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