Cancel an appointment – The Quarter Jack Surgery

Use the form below to cancel your appointment.

Name(Required)

First Last

Date of birth(Required)

Daytime telephone number(Required)

Email address

Enter Email Confirm Email

Date of the appointment you wish to cancel(Required)

Time of the appointment you wish to cancel(Required)

Name of the health professional you are booked to see

Please let us know briefly why you are cancelling this appointment

Not for urgent medical help(Required)

Yes, I understand this form is NOT for urgent medical help