Barwon Health

Changing or cancelling an outpatients appointment

For urgent enquiries, please call our switchboard (03) 4215 0000.

Please complete this form if you wish to change or cancel an outpatients appointment. If you wish to speak to a staff member about your appointment, please call us during business hours on 4215 1396.

*All fields marked with an asterisk are mandatory

Patient Information

First Name:*

Last Name:*

Date of Birth:*

UR/Hospital Number (6 or 8 digit number located underneath your name and address on your letter)

Appointment Information

Appointment Date*

Appointment Time*

Speciality/Clinic

I would like to:

I understand that if I cancel my appointment, I will need a new referral from my GP to be seen in Outpatients.

Reason for cancelling my appointment:

Other:

Comments or additional information:

Details of person completing request

Relationship to Patient:*

Daytime contact number:*

Email:*

Confirm Email:*

Verification

Last Modified: Monday, 11 December 2023

Outpatient Services

Changing or cancelling an outpatients appointment

For urgent enquiries, please call our switchboard (03) 4215 0000.