CANCEL AN
APPOINTMENT
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Appointment Information
> Cancel an Appointment
Change an Appointment
Please keep your appointment request within a year from your last visit. Requests beyond a year will be treated as new / first appointments.
**Patient's Name:
(as in NRIC/Passport)
**Patient's NRIC / Passport No:
**The appointment to change is on:
1
2
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5
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Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
at this time:
Hr
Min
at this location:
Suite 2A
Suite 2B
Suite 1A
Suite 1B
Suite B1A
Suite B1B
Geriatric Medicine Clinic
Contact Information
Name:
Please type in name of contact person, if different from the name above
E-Mail:
Phone[Home]:
Phone[Office]:
Handphone:
Pager:
Fax:
Please call between
8 am
9 am
10 am
11 am
12 pm
1 pm
2 pm
3 pm
4 pm
5 pm
and
9 am
10 am
11 am
12 pm
1 pm
2 pm
3 pm
4 pm
5 pm
6 pm
Please ensure information is correct for a hassle-free submission
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