Cancel an Appointment

Are you registered for Online Services?

If you are registered for this facility then you can cancel the appointment and re-book all at the same time.
Simply logon to the online portal and visit the appointments section.

Appointment Cancellation Form

Please use this form ONLY if you are not registered with our Online Services (Patient Access).
Thank you
Please use the Form below to cancel appointments more than 24 hours in advance.
If you are unable to attend an appointment please let us know in plenty of time to assign your appointment time to another patient.

Name *

First

Last

Email *

Confirm Email

Date of Birth *

Please use format day/month/year e.g. 12/05/1979

Telephone / Mobile Numbers

Your appointment was with? *

Date of your appointment *

Time of your appointment *

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

Data Storage *

I consent to the Practice collecting and storing my data from this form

Mawney Road Surgery

206 Mawney Road | Romford | Essex | RM7 8BU | Tel: 01708 739 379

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Appointment Cancellation Form

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Mawney Road Surgery

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