Cancel an Appointment

Patients and carers can request an appointment at any one of our Queensland X-Ray practices. Simply complete the form below, and one of our booking staff will contact you on the working day to confirm the availability of the appointment requested.

Patient Title -Please Select- Mr Mrs Master Miss Ms Dr

*Required Field First Name !Field requires attentions

*Required Field Last Name !Field requires attentions

*Required Field Date of Birth !Field requires attentions  

*Required Field Gender !Field requires attentions

• Male
• Female

Address

Suburb/Town

State -Please Select- Queensland New South Wales Australian Capital Territory Victoria Tasmania South Australia Western Australia Northern Territory

Postcode

*Required Field Email Address !Field requires attnetions

First Name

Last Name

Contact Phone Number

*Required Field Current Appointment Time ! Field requires attentions

*Required Field Appointment Area !Field requires attentions -Please Select- Brisbane Mackay Cairns Toowoomba Townsville Gold Coast

*Required Field Appointment Practice !Field requires attentions -Please Select-

Reason for cancellation