Fleggburgh 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:

Please confirm by ticking the box below that you have read and accept our Terms & Conditions for using this online facility to cancel your appointment:


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.

Are my details secure ?

The Internet is not a secure medium. Please refer to our privacy page for further details. If after reading this you do not wish to use this Questionnaire, please call or write to us requesting a paper copy of the Questionnaire.

Other Notes:

All fields marked with * are mandatory.