Cancel an appointment

Last Updated: 04/03/2024

Personal Detail

Full Name *

Date of Birth *

Phone Number *

Email Address

Your Appointment details

If you cancel your appointment via this form and need to reschedule a new appointment please contact the surgery on 01296 310940 to rebook.

I understand that this form collects my name, date of birth and any other personal information that I choose to provide. This is to confirm I am registered with the practice; to allow the practice team to contact me and to update the medical records held by them and their partners in the NHS. I understand that I am able to read the privacy policy (Located at the footer of the website) to discover how they protect and manage my submitted data. *

I consent to the practice collecting and storing my data from this form and understand that anything not relating to this form will not be actioned.

Appointment Type *

Name of clinician or Nurse if known

Appointment date *

Appointment Time If known

Reason for appointment cancellation *

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Cookies on the Berrycroft Community Health Centre website

Cancel an appointment

If you cancel your appointment via this form and need to reschedule a new appointment please contact the surgery on 01296 310940 to rebook.

Further Information

Connect With Us