APPOINTMENT CANCELLATION FORM

Please take note of our cancellation policy and fee for missed appointments. You can easily cancel your booked appointment using this form. Please try to give us as much notice as possible so that we can offer your slot to another patient. Cancellation forms received within two hours of the appointment time will be marked as "did not attend" and you may be charged a fee. Please call us if you need to cancel at short notice. 

Name of patient

Date of birth of patient

Contact telephone number

Date and time of appointment

Please cancel the booked appointment for the above patient.

Yes

No