Change/Cancel your Physiotherapy or Occupational Therapy appointment

Each year valuable resources are wasted because patients do not turn up for their appointment or admission. If you cannot attend or no longer require your appointment, please let us know as soon as possible so that we can offer the slot to another patient.

Outpatient Physiotherapy and Occupational Hand Therapy Booking Line: 01582 497045 or 01582 718680

Change/Cancel Appointment Form

Please complete all fields marked with an astrix (*)

I want to*

Rearrange my appointment Cancel my appointment and I do not wish to rebook Book a follow-up appointment

Title

First Name*

Family Name*

Address

Daytime contact number*

Date of birth*

NHS hospital number (if known)

Clinic or Speciality*

Therapist name

Date of existing appointment*

Time of existing appointment*

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

Yes No

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.

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