Do you need to cancel or change your appointment?

Please do not submit this form if your appointment is in less than 3 working days from now. Instead, call (03) 9076 2025 to cancel or change your appointment.

Patient details

Medical Record Number (MRN)

Your MRN can be found on your appointment letter or reminder text message.

First Name

Last Name

Date of birth

Preferred contact number

Email address

Your first name

If different to the patient details above.

Your last name

If different to the patient details above.

Relationship to patient

Current appointment details

Appointment date

Appointment time

Hospital

Clinic name

This will be listed on your appointment letter or reminder text message.

Required change to my appointment

Please note, by cancelling your appointment you acknowledge that you will need to visit your GP to obtain a new referral in order to book another appointment with this clinic.

If you choose to change the date or time of your appointment there may be a wait for the next appointment to become available.

I would like to... Cancel my appointmentChange the date or time of my appointment

Please tell us why you are cancelling or need to change your appointment.