Cancel Appointment Request

* Required field. Please note: you will need to fill in all required fields in order to submit your request to us.

* Patient Name

* Date of Birth

* Preferred Email

Parent or Guardian

* Preferred Phone Number

Brief Reason for Cancellation

* Date of your appointment?

* Which Location

Disclosure

Please be sure to cancel your appointment at least 24 hours prior to the scheduled appointment time, per DMC’s Late Cancellation/No Show Policy.

If you need to reschedule for another time, please call 603-537-1300 or use our Make an Appointment Form.