Changing or cancelling an outpatients appointment

Please fill out this form if you wish to change or cancel an outpatients appointment at University Hospital Geelong Outpatients Department.

If you wish to speak to a staff member about your outpatients appointment, please call us during business hours on 4215 1396.

If you would like to share any ideas or suggestions about your Barwon Health experience, please click here.

*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: Wednesday, 16 December 2020

Outpatient Services