RBCH Online Appointment Cancellations

Please use the form below to cancel an outpatient appointment. All your data will be encrypted before it is stored.

Please note that this form is for the cancellation of outpatient appointments only. You cannot use it to cancel surgical or pre-admission assessment appointments.

Your Details:
Hospital No: *
Surname: *
First Name: *
Main Tel No: *
Mobile Tel No:
Email Address:
Date of Birth: * - -
   
Appointment Details:
Appointment Date: * - -
Would you like to re-book your appointment? *
  Yes
No
Reason for Cancellation: *
 
Additional Comments: