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Reschedule, cancel or check your clinic appointment here

This form is designed to make it easier for you to let us know if you wish to cancel or reschedule your appointment.

You can also use this form if you have forgotten your appointment date or time.

For patients that have an appointment at Gilbert Hitchcock House that requires checking, changing or cancelling, you will need to contact them directly otherwise your appointment will not be amended as requested.

There is an option at the bottom of this form where you can register your mobile phone number with us and receive text messages to remind you of your appointment.

Please read all the instructions and then complete the form below. When you have completed the form, please read and accept the terms and conditions and then submit the form.

All the information required for this form to reschedule or cancel an appointment appears on your hospital appointment card or letter.

* Fields in red are required

Patient details

Patient name: *

If you are filling out this form for somebody else please tick this box and fill in your name and relationship to the patient and then complete the form. We will then contact you to discuss the issues further.

Patient's NHS or Bedford Hospital unit number:

Patient's date of birth (dd/mm/yyyy): *

/ /

Patient's postcode: *

Appointment details

Consultant's name (if known):

Date of appointment (dd/mm/yyyy):

/ /

Time of appointment:

Contact details

Home telephone number: *

Address: *

Email address:

Mobile phone number:

Bedford Hospital provides a text message service which reminds you about your appointments. If you do NOT wish to receive appointment reminder texts please untick this box.

What would you like to do?

I would like to cancel my appointment and I do not require another appointment

Please note:

  • In certain circumstances your appointment may be essential and therefore you may receive a phone call to discuss this with you before your appointment can be cancelled.
  • If you cancel your appointment you may be taken off the waiting list
  • If you then decide you require that appointment you will need to see your GP to be referred again
  • A cancellation letter will be sent to you to confirm that you have cancelled your appointment
I would like to reschedule my appointment

Please note:

If you tick this option, we will cancel your original appointment and will then either automatically send you another appointment or contact you to arrange another appointment. Please tick which option you prefer:

Please automatically send me another appointment.
Please contact me to discuss a new appointment.
I would like to check the date, time or location of my appointment

How should we contact you?

I would prefer to be contacted by:
Home telephone
Mobile telephone

Additional details

Below you can include any supporting information regarding your appointment and you can also use this to change, correct or update any of your details.

Please note that only your details held by the hospital will be changed and not those held by your GP surgery. Your changed details will be noted in your medical notes and confirmed at your next appointment.

Please do not use this space for any request other than those relating to your appointment arrangements. For any other queries visit the contact us page.

Terms and conditions

We will always treat the information you send us with the strictest confidence.

This form sends your information via an unencrypted email to a Bedford Hospital email address. If you are concerned about the security of your information and would prefer to speak to a member of staff please telephone the hospital switchboard on 01234 355 122 to change, cancel or rearrange your appointment.

By providing your email address or mobile phone number you are giving consent to Bedford Hospital responding to your query using these means of communication (your preferred method will be used first). This will be limited to details of date and time of any appointments. We will not contact you by email or mobile phone regarding any other issues relating to your condition or type of appointment.

If you have rescheduled or cancelled an appointment, a letter will be sent to you to confirm new arrangements. If you have not heard from us within seven working days please contact the hospital using the using the details on the contact us page.

Online appointments enquiries are processed Monday to Friday between 9am and 5pm, if your enquiry is urgent and outside these hours please telephone the hospital switchboard on 01234 355 122.

By ticking this box I confirm that I have read and accept all the terms and conditions set out above *.