Holiday Cancellation Request

Full name

Date of Birth

Full postal address

Mobile telephone number

Email address

Holiday destination

Starting Date of the Holiday

Last Day of the Holiday

Reason for holiday cancellationPlease provide as much as information as you can. Please do not hesitate to include any medical conditions that you may want to include to support your letter.

Any other supporting information

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Phoenix Family Care (GP Surgery in Coventry) • 103 Leamington Road, Coventry, CV3 6GQ .

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.