Arrange an Appointment

If you would like to contact us about an appointment by telephone, then you can ring the Appointment Centre Administrator during office hours: 0300 555 4567. Calls from landlines are charged at local rates.

We understand that some of our patients may have difficulty in contacting us by telephone. If this is the case, you can contact us:

By Direct E-mail: appointments@wwl.nhs.uk

By Post:
Appointment Centre
Leigh Infirmary
The Avenue
Leigh
Lancashire
WN7 1HS

Please complete the fields on the form below and we will contact you (using your preferred contact method) to negotiate an appointment. For your peace of mind, your details are encrypted and sent securely to us. It is important to complete all mandatory fields and as many of the other fields as possible to allow us to identify you. For your information, the successful submission of your request will be confirmed with the appearance of a thank you message.

* Have you received a letter asking you to make an Appointment (required)
Yes
No

* Your Full Name: (required)

NHS Number or Hospital Number:

* Date of Birth:

* Address:

* Postcode:

Home/Mobile Telephone Number:

Email Address:

* New or follow up appointment:
New Appointment
Follow-up Appointment

* How Would You Like Us to Contact You?:
Email
Post
Telephone

Do you have any information or communication needs? Do you need your information in a different format? If so please state:
Audio
Large Print
Braille

Other (Please state)

Department or Speciality:

Please let us know if there are any dates during the next 2 months, that you would not be able to make:

Do you require a sign language Interpreter?:
Yes
No

* My Consent (please tick):
I consent to the Trust using the details supplied on this form to contact me about my appointment:

Please enter the characters you see above.

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