Change Face-to-Face Appointment to Telephone

Appointment Change - ONLY from Face to Face to Telephone

This form is used to request a change from a face-to-face appointment to a telephone consultation. Please note that we require a minimum of 4 hours’ notice to make this change. Requests made with less than 4 hours’ notice may result in the appointment being marked as Did Not Attend (DNA), and you will need to submit a new RapidHealth form to request another appointment.

Please complete this section if you are completing the form on behalf of someone else.

About You (The Patient)

Name  Required
Date of Birth  Required
Address  Required

Appointment Details

Date of Face to Face Appointment  Required
Time of Face to Face Appointment  Required
:
Are you requesting to change this appointment to a telephone consultation?  Required
Reason for requesting a telephone consultation:  Required

Is your problem suitable to be discussed over the phone?  Required
Do you understand that the clinician may still advise a face-to-face appointment if needed?  Required
Do you understand that the clinician will not call you at the time you booked your face-to-face appointment.  RequiredTelephone consultations may take place at any time between 8:00am and 6:30pm. In some cases, calls may occur after 6:30pm, depending on the clinician’s clinic running time.
Please confirm you understand the notice period requirement:  Required
Privacy Protection  Required

Additional Information

Carers

Chaperoning

GDPR, Data Processing and Subject Access Request (SAR)

Infection Control

Long Term Conditions

Summary Care Records

Zero Tolerance Policy

Non-NHS Services

Patient Participation Group

Responsibilities

Talking Saves Lives

Winter Health

Community and Locality Services

Complaints Policy