Imaging Appointment Cancellation/Change Form – Bedford Hospital

If your appointment is within the next 4 days or for an appointment in maternity ultrasound , do not use the e-form, but please email ImagingAppointments.Bedford@bedsft.nhs.uk or contact the number on the appointment form.

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

Please fill out the below form to cancel or change your appointment.

Imaging Appointment Cancellation/Change Form - Bedford Hospital

Please complete all fields marked with an astrix (*)

Patient Details

Patient Name*

Patient's NHS or Bedford Hospital unit number

Date of birth*

Patient Postcode*

Appointment Details

Type of x-ray or scan

Date of appointment

Time of appointment

Contact Details

Home telephone number*

House number and street name*

Town/city*

Postcode*

Email*

Mobile phone number

What would you like to do?

I would like to cancel my appointment and I do not require another appointment

Please note:

In certain circumstances your appointment may be essential and therefore you may receive a phone call to discuss this with you before your appointment can be cancelled.
If you cancel your appointment you will be taken off the Imaging waiting list
If you then decide you require that appointment you will need to see your GP/consultant to be referred again

I would like to reschedule my appointment

If you tick this option, we will cancel your original appointment and will then either automatically send you another appointment or contact you to arrange another appointment. Please tick which option you prefer:

Please automatically send me another appointment. Please contact me to discuss a new appointment.

How should we contact you?

I would prefer to be contacted by

Home telephone Mobile telephone Email

Additional details

Below you can include any supporting information regarding your appointment and you can also use this to change, correct or update any of your details.
Please note that only your details held by the hospital will be changed and not those held by your GP surgery. Your changed details will be noted in your medical notes and confirmed at your next appointment.
Please do not use this space for any request other than those relating to your appointment arrangements. For any other queries visit the contact us page.

Supporting Information

Terms and conditions

We will always treat the information you send us with the strictest confidence. This form sends your information via an unencrypted email to a Bedfordshire Hospitals email address. If you are concerned about the security of your information and would prefer to speak to a member of staff please telephone the hospital switchboard on 01234 355 122 to change, cancel or rearrange your appointment. By providing your email address or mobile phone number you are giving consent to Bedfordshire Hospitals responding to your query using these means of communication (your preferred method will be used first). This will be limited to details of date and time of any appointments. We will not contact you by email or mobile phone regarding any other issues relating to your condition or type of appointment.
If you have rescheduled or cancelled an appointment, a letter will be sent to you to confirm new arrangements. If you have not heard from us within seven working days please contact the hospital using the details on the contact us page.

By ticking this box I confirm that I have read and accept all the terms and conditions set out above *

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