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(Required)

Last Name(Required)

Date of Birth(Required)

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

Reason for cancelling my appointment

Other

Comments or additional information

Details of person completing request

Daytime contact number(Required)

Email(Required)

Enter Email Confirm Email

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Page last updated: April 30, 2024