Russell House Surgery

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Appointments Cancellation

Cancelling Your Appointment:

Please use the form below to cancel your appointment with us.

Your appointment must be at least one working day in advance to use this facility. If this is not the case, please use one of our alternative cancellation methods.

Important: Please only use this facility to cancel appointments with one of our Doctors, Nurses or other surgery staff members (it should not be used to cancel hospital appointments).

Appointment Cancellation Form:

Patient Details:

Firstname (1st 3 Chars): *

Surname (1st 3 Chars): *

Date of Birth (dd/mm/yyyy): *

 /   / 

Appointment Details:

Clinician Name:


Appointment Date (dd/mm/yyyy): *

 /   / 

Appointment Time (hh:mm): *

: am pm

Terms & Conditions:

By clicking on the check box you are confirming that, with regard to this facility, you agree with the Terms and Conditions for its use, you consent to the practice collecting and storing your data from it and you give your consent for the practice to contact you (by email, text message and/or telephone) about it.


What Does this form do ?

Use this form to tell the surgery that you are unable to attend an appointment. This enables us to offer your appointment to someone else and helps to reduce waiting times.

To use this facility, your appointment must be at least one working day in advance of the current time. E.g. If it is currently 10am on Monday you cannot cancel an appointment earlier than 10am on Tuesday.

If you are unsure, enter your details anyway and the system will tell you if we can accept the cancellation using this method.

Who is the Clinician ?

This is the name of the Doctor, Nurse or other member of staff that your appointment is with. If you do not know the name of this person leave the field blank.

Other Notes:

All fields marked with * are mandatory.