Change or Cancel Appointment

Use this form to change or cancel your Radiology Examination appointment. Once the request is received, we will contact you directly to finalise either the new appointment details or to confirm cancellation.

Please do not use this form if your change request is urgent.

Reschedule or cancel appointment *

Reschedule

Cancel

Request for *

Clarence Valley Imaging

North Coast Radiology

Which North Coast Radiology branch?

Which Clarence Valley Imaging branch?

Type of Examination?

Date of current appointment

Preferred date for rescheduled appointment

Preferred time of day

Any time

Morning

Lunchtime

Afternoon

Reason for cancellation

Your Details

Name *

First

Last *

Last

Best daytime phone number *

(incl area code)

Email *

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