Change/Cancel My Appointment

Change or cancel your Specialist Outpatients appointment

Submit the form below or contact us on 03 5320 4221. Find out more about Specialist Outpatients clinics at Grampians Health Ballarat.

Do you need to change or cancel your appointment?

Submit this form or alternatively contact us on 03 5320 4221.

To ensure optimal medical care and for privacy reasons, medical advice cannot be provided via email.

Your name *

Your email *

Your daytime phone number *

Preferred method of contact *

Email
Phone

Date of birth

Appointment action *

Change appointment
Cancel appointment

Appointment date *

Appointment time *

Additional comments

Consent for storing submitted data *

Yes, I give permission to store and process my data

1 Drummond Street North
Ballarat VIC 3350

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