Change of Appointment Form

Please only use this form if you would like to change an existing appointment with the:

Health Visiting and School Nursing Service
Speech and Language Therapy Service
Mental Health Support Teams (MHST) in Schools

If your appointment is within 48 hours, please call 0300 300 0123 instead. Do not use this form if you are requesting a new appointment or for anything else.

Patient Details

Child, young person or adult's full name: Required

Child, young person or adult's date of birth: Required

Postcode the child, young person or adult lives at: Required

Child, young person or adult's NHS number: (if known)

Find an NHS number

Details of person completing form

Full name of person completing this form: Required

Date of birth Required

Home postcode Required

Appointment details

Date of appointment: Required

Your mobile number Required

Please select a preferred day for your appointment Required

Monday Tuesday Wednesday Thursday Friday

Please select a preferred time for your appointment Required

Mornings 9am - 1pm Afternoons 1pm - 3pm

Consent and information sharing

I confirm I am requesting an appointment change only, and that my appointment time is more than 48 hours away.

I understand how my data will be used. I consent to the storage of my data in accordance with the East of England Community Health and Care NHS Trust (EEC) privacy policy.

Find out more about the East of England Community Health and Care NHS Trust privacy policy