Cancel outpatient appointments - Canberra Health Services

Patient first name *

Patient last name *

Patient date of birth *

Day Month Year

Patient address *

Who are you cancelling for?

Your first name

Your last name

Relationship to the patient

Appointment details

What is the appointment for? *

What is the date and time of the appointment? *

Day Month Year

Would you like us to contact you to reschedule? *

Thank you for taking the time to cancel the appointment. This helps us provide a better service.