Missed outpatient appointments

Hospital appointment was at (if known):

Date of appointment (if known):

Please use date format DD/MM/YYYY

Medical speciality or type of scan:

Reason for missing appointment

Please give more information:

Do you feel you still need another appointment arranging?

Yes

No

Do you have any upcoming holidays or other engagements that mean you will not be available on certain dates?

Yes

No

Please enter the dates you will be unavailable:

Please confirm your current contact phone number:

This so we can ensure the booking team can contact you to rearrange appointments if required.

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