Cancel an Appointment

Please use this form to notify us if you need to cancel your GP or Practice Nurse appointment so that we can allocate the time to another patient. Please give as much notice as possible when cancelling appointments online.

If your appointment is today, please telephone the surgery on (practice phone number).

Please note this form is NOT for booking appointments.  No appointment allocation will be granted by completing this form for future appointment requirements.

1Your Details

Please provide in the format dd/mm/yyyy
This will allow us to locate you quickly on our Patient Database.

2Your Address

3Your Contact Details

4Appointment Details

DD/MM/YYYY
HH:MM

Although sending information across the Internet means that privacy of data cannot be absolutely guaranteed, our online forms offer high levels of security. The forms use HTTPS and TLS (using a 2048 bit certificate) to encrypt data sent to and from your computer when using the site and our server environment is PCI DSS certified - the highest standard of security associated with e-commerce and online finance solutions.

Form submissions are stored on the server for 28 days and are encrypted and secured with a private key known only by the GP Practice.

Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

© Dordon and Polesworth Group Practice 2017
Dordon Surgery - 162 Long Street, Dordon, Tamworth, Staffordshire, B78 1QA
Polesworth Surgery - High Street, Polesworth , Tamworth, Staffordshire, B78 1DU
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