Cancel an Appointment

Please use this form to cancel appointments more than 24 hours in advance. If you are unable to attend an appointment please let us know in plenty of time to assign your appointment time to another patient.

First Name *

Last Name *

Email *

Enter Email

Confirm Email *

Confirm Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Appointment with

Date of Appointment *

Time of Appointment *

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form.

Practices Portland/Hurlford	01563 522411
NHS 24	111

Cancel an Appointment

Privacy Policy

Portland Medical Practice

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