College Green Medical Practice
Cancel an Appointment Form
Patient and Appointment Details
(Stage 1 of 2)
Full Name
Date of Birth (For example, 31 3 1980)
Contact Number (Mobile)
Email Address
Address
Enter the Date of your Appointment (For example, 31 3 1980)
Enter the Time of your Appointment (For example, 14 30)
If you would like to reschedule your appointment, enter the desired date below and we will contact you with an exact time (For example, 31 3 1980) (Optional)
I consent to being contacted via the details given above. I agree to the
privacy policy.
Yes
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