[PDF] Fitting Your Sling - University Hospitals Coventry & Warwickshire

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Validate form submission What change are you making to your appointment? [Please select...] I need to change my appointment I need to cancel my appointment I have lost the details of my appointment I have not received my letter I need to change or cancel my scan or Xray First name * Last name * Date of Birth * Contact number * Email address Postal Address * Which hospital was your appointment with? [Please select...] University Hospital Coventry Hospital of St. Cross Rugby George Eliot Hospital Warwick Hospital Burton Hospital Other Date and time of appointment * Which department or clinic is your appointment with? If you don't know, please leave this blank * Do you need a letter sending with your new appointment details? Yes No Are there any dates which you are unavailable for? Please note, cancelling an appointment will remove you from the waiting list completely. Please let us know your reason for cancelling. You no longer require an appointment Yes No Your condition has improved so you don't feel you need this? Yes No You have you been able to access treatment or support elsewhere? Yes No Do you have any special needs or requirements for your care? Yes No Please specify your special needs or requirements If you choose to reschedule an appointment, we will only cancel the old appointment once you have confirmed the new appointment. If your appointment is within 24 hours, please call the Booking Centre on 0800 252 060. We will inform your GP of this change. We will now be able to offer this slot to another patient on our waiting list. Thank you for letting us know. If your appointment is within 10 working days, please call the Booking Centre on 0800 252 060. Cookies are currently disabled.Please review our Cookie Policy to enable cookies and Submit this form. Submit