St Vincent's Hospital Melbourne Specialist Clinic Appointment Change Form

Please fill out this form if you wish to change or cancel a Specialist Clinic appointment, or if you need to update your details.

If you wish to speak to a staff member about your Outpatients appointment, please call us on (03) 9231 3475 Monday to Thursday 8.30am to 4.30pm or Friday 8.30am to 4.00pm. During busy times, you may be placed in a call queue.

Patient Details

First Name*

Last Name*

Date of Birth* (dd/mm/yyyy)

Appointment Details

Appointment Date* (dd/mm/yyyy)

Appointment Time

UR or hospital number

This is a 6 to 7 digit number located top right hand corner of your appointment letter

Speciality *

Clinic (if known)

I would like to *

Update my details

Cancel my appointment

Change my appointment

I understand that if I change my appointment, I will be given the next available appointment.
I understand that if I cancel my appointment, it is my responsibility to rebook.

Contact Details

Are you the patient? *

Yes

As you have said you aren't the patient, please let us know your name.

Name

My relationship to the patient is:

Contact Phone Number *

Updated address

Has your address has changed? If yes, enter it below - otherwise you can leave this blank

Any other information?

If there's anything else we might need to know, include it below

Preferred contact method*