Nottingham University Hospitals - NHS Trust
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Contact us about your clinic (outpatient) appointment

Please use this form to contact us to change or completely cancel your hospital appointment.

  • use this form regarding your own appointment at Nottingham University Hospitals Outpatients
  • you can use this form on behalf of someone else (e.g. a child or next of kin)

Please don't use this form to contact your GP or for research projects booked direct with the investigators.

To change or cancel X-Ray appointments click here

Where boxes are marked REQUIRED, they must be filled in before you can submit the form.


The information you will need is on your appointment card or letter:
About the person who has the appointment:

Patient Name
as on the appointment card/letter
REQUIRED

 
Form completed by (if not patient)
I am contacting you on behalf of the person named on the appointment card/letter
Your name and relationship with the patient named above
if you are not the patient named above
NHS number of patient
NHS or NUH hospital number
OPTIONAL (but very helpful)
Date of birth (day, month, year)
REQUIRED 		 
About the appointment:
Location
(please check boxes as appropriate)
If your appointment is for one of the following then it is likely that it is in the NHS Treatment Centre at QMC campus. In this case you will need to telephone 01159 705 800 instead of using this form.
  • Cardiology
  • Colorectal Surgery
  • Colposcopy
  • Dermatology
  • Gastroenterology
  • Gastrointestinal
  • General Gynaecology
  • HPB / Upper GI
  • Menopause Clinic
  • Orthopaedics
  • Respiratory
  • Vascular
Date of appointment that you wish to change
 REQUIRED 		 
Time of appointment that you currently have
REQUIRED 		 
About contacting you:
Daytime telephone number or mobile number
If it is not a Nottingham number, please include the area code.
REQUIRED 		 
Address
E-mail address
Your request or message:
Please select carefully from the following options:

I wish to cancel my appointment completely and do not require a replacement to be made

I wish to rearrange my appointment

I wish to ask you about my appointment

I prefer to be contacted:

by phone (I have included my daytime phone number above)

by e-mail (I have included my e-mail address above)

by post (I have included my full postal address above)
I understand that if you completely cancel this appointment for me and I later change my mind, I will need to return to see my GP for a new referral.

I understand that I need to cancel or rearrange my own hospital transport and this will not automatically be done for me.
TRANSPORT

Please don't forget to cancel or re-arrange any transport that may have been booked for this appointment by phoning 0115 840 5898.

Any other message (you can use this to change your contact details or explain why you want to change the appointment). Please indicate any dates that you are unavailable.

Enter the code in the box below, and click the button to send your information to the hospital

This form sends information to a Nottingham University Hospitals NHS Trust e-mail address. We will always treat the information you send us with the strictest confidence and will not pass any information on to third parties. If you feel concerned about the security of the world wide web, please use another form of contact to change your appointment.

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