Patients & Visitors

Radiology Department


Please do not use this form if your appointment is for a pregnancy related scan - you must call the relevant department as detailed in your appointment letter to cancel or reschedule.

This form is only for appointment enquiries, not queries about your medical condition.

Your full name:

Your email address:

Date of birth:
For example, 12/10/1965

NHS / Medical Record Number:
For example, 943 476 5919

I would like to:
Cancel my appointment
      No further appointment required
Change my appointment
      A further appointment will be sent to you in due course

Please select appointment type:
US (ultrasound)
XR (x-ray)

Please provide any other information which may help us rebook your appointment appropriately (dates unavailable):

I (being the patient) confirm that my enquiry is not urgent.

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