Please be aware that if you cancel your appointment twice, we may discharge you back to your GP.
If you have a general query regarding your appointment or you need to cancel / change your appointment as a matter of urgency, it is recommended that you phone the relevant department to speak to them directly.
The department telephone number will be located on your appointment letter or appointment card.
Do not submit this form if:
- Your appointment is within the NEXT 48 HOURS
- You have an appointment for an X-ray, CT, MRI or Ultrasound
- You have an appointment in Maternity or Obstetric Outpatient or Ultrasound
- You have a Palliative Medicine or Chemotherapy appointment
If your appointment applies to any of the above you must contact the relevant department directly.
For your information:
- This form is for Derby Hospital Outpatient appointments ONLY
- You can submit this form for your own appointment OR on behalf of someone else (e.g. a child or next of kin, carer or advocate)
- All the information you need to complete this form is available on your appointment card or letter
- If you wish to cancel more than one appointment on the same day you will need to submit a separate form per appointment.