This site is best viewed with a modern browser. You appear to be using an old version of Internet Explorer.

Outpatient appointment request form

This form can be used to book, cancel and change outpatient appointments

The Patient Contact Centre will deal with your request, usually within two working days (it may take longer if full details are not provided). For 'on the day' or 'next day' cancellations and changes, please call us instead:

Patient Contact Centre
Tel: 01865 231405
Monday to Friday 8.00am - 6.00pm

The information you submit via this form is secure. However, unless you specifically ask us not to, we may contact you by email; these emails will include some or all of the personal information that you give us in this form. Please note that emails are not a secure method of communication. If you are concerned about your personal information being sent in this way, please telephone the Patient Contact Centre instead.

If you would like to know more about how your information is processed or about your data rights, please see the Trust Privacy Notice.

Fields marked * are required.

Referral

Please confirm that you have been referred by a health professional *

Your Details

First Name *

Last Name *

Date of Birth *

Address *

Postcode *

NHS Number/Hospital Number/Booking Reference *

GP Practice *

Contact Details

Preferred method of contact

Telephone *

Mobile number

Email address

Are you happy to receive reminders about your appointment via telephone call and text message?

YesNo

Please note, if you answer No, you will not receive any phone calls/text reminders from OUHFT only letters.

About your appointment request

Please let us know how you would like to change your appointment *

Rebook a previously cancelled appointmentRearrange an existing appointment or cancel my appointment

Please add any extra information below

Consent

We will use the information provided for the purposes of processing your request to book, cancel or change your outpatient appointment. We will not pass your details onto third parties. For full details of how we collect and use your information, see our Trust privacy notice.

I consent to my information being used as described above *