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:

By Post:
Appointment Centre
Leigh Infirmary
The Avenue

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?*

Your Full Name*

NHS Number or Hospital Number

Date of birth* Please use dd/mm/yyyy format



Tel No. 


New or follow up appointment

How would you like us to contact you?

Do you have any information or communication needs? Do you need your information in a different format? If so please state

Other (Please State) 

Department or Specialty

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?*

My Consent