Cancel An Appointment

Please do not use this form if you are cancelling an appointment within 2 hours of your scheduled time. If your appointment is in less than 2 hours, please call a Patient Service Representative at (610) 861-8080 to ensure your request is expedited.

Fields in RED Are Required

What type of appointment are you cancelling:	PhysicianTherapyImaging
Patient's Name:
Date of Birth (mm/dd/yyyy):
Patient's Email:
Phone Number:	() -Second partThird part
Best time to contact you:	Morning Evening Any Time
Date of Original Appointment:	Date and time
Time of Original Appointment:
Appointment Scheduled With:	Enter Physician or Therapist Name
Location:	Allentown Bethlehem Campus @ Schoenersville Rd. Bethlehem Campus @ Highland Ave. Easton Campus @ Greenwood Ave. Easton Campus @ Emerick Blvd. East Stroudsburg Brodheadsville Hazleton Lehighton Phillipsburg