Change/Cancel Appointment – Luton and Dunstable University Hospital

Please note, if your appointment is due within the next 10 working days, please do not use this form. Instead, please use the contact numbers on your appointment letter to make us aware of this late notice change.

If you fill in the form within 48 hours of your appointment, you will be put down as DNA, therefore please call the number above.

(Please note Monday morning and lunch times are usually the busiest, so please avoid calling during these times if possible.)

Changing your appointment

If the appointment you wish to change is within two working days we will aim to contact you within 48 hours, otherwise we will notify you by post within one week.

Cancelling your appointment

Once we have received your request we will cancel your appointment. However, if you choose to cancel, you will not be offered a new appointment unless you are re-referred by your GP.

Urgent Referrals

If your GP has informed you that your referral is urgent, this is because you should be seen within a two week period. Please bear this in mind when requesting a change of appointment and ensure that you book your new appointment within this period.

The form below should not be used for appointments for Maternity, Breast Screening, GUM, Endoscopy, Imaging/X-ray, Limb-Fitting, Orthotics, Neurophysiology, Physiotherapy, Speech and Language Therapy, Audiology, Anaesthetics or Mental Health.

You should contact the department direct on the telephone number quoted on your appointment letter for these appointments.

Change/Cancel Appointment Form

Please complete all fields marked with an astrix (*)

I want to*

Rearrange my appointment Cancel my appointment

Title

First Name*

Family Name*

Address

Daytime contact number*

Date of birth*

NHS hospital number (if known)

Clinic or Speciality*

Date of existing appointment*

Time of existing appointment*

Interpreter booked?*

Yes No

If I am not available to contact by phone I am happy for you to leave a message on an answer machine*

Yes No

Consultant (if known)

Cancellation Reason

To help us avoid future inconvenient dates, please indicate details of dates and times when you cannot attend hospital

Please check the box to agree with the terms and conditions.

Please note: We are unable to transmit appointment details via email for reasons of confidentiality, This form sends information to a Luton & Dunstable University Hospital email address. We always treat your information with the strictest confidence and will not pass any information to third parties. The L&D cannot guarantee 100% security when information is in transit over the world wide web. If you have any concerns regarding the security of the world wide web please call the hospital directly on 01582 561385 to cancel your appointment.

Thank you for your enquiry, we will be in touch shortly.