Screening 2 : Cancellation

Date

DateHourMinutesAM/PM Option

Name of person due to be screened*

First NameLast Name

Email address*

Contact number*

Area CodePhone Number

Screening was being carried out by*

I want to*

Re-schedule my screening appointment for another date/timeCancel my screening appointment - with no intention of re-booking

Please note: This cancellation is automatically date and time stamped upon submission for validation purposes

Submission*

I am submitting this form BEFORE 5pm on the day PRIOR to my scheduled appointmentI am submitting this form AFTER 5pm on the day PRIOR to my scheduled appointment

Reason for cancellation

You can choose to leave this field blank if you wish

One of our screeners will contact you to re-book your appointment - there is no need to re-submit an enquiry form.

Important - as per our cancellation policy (as agreed at the time of booking)

If you are submitting your re-schedule request before 5pm on the day prior to your scheduled appointment, the fee you have paid will be retained by the DABBGL as payment for your new screening date/time.

One of our screeners will contact you to re-book your appointment - there is no need to re-submit an enquiry form.

Important - as per our cancellation policy (as agreed at the time of booking)

If you are submitting your re-schedule request after 5pm on the day prior to your scheduled appointment, your screening will be considered "missed" and the fee will not be refundable or transferable. If your late request has been made due to an emergency, please complete the "Reason for cancellation" box above for consideration by the DABBGL.

Important - as per our cancellation policy (as agreed at the time of booking)

If you are submitting your cancellation before 5pm on the day prior to your scheduled appointment, the fee you have paid will be refunded to you by cheque within 28 days. Please complete the details below to allow us to process your refund.

Cheque to be made payable to

TitleFirst NameLast Name

Postal address

Street Address

Street Address Line 2

TownCounty

Postcode

Important - as per our cancellation policy (as agreed at the time of booking)

If you are submitting your cancellation after 5pm on the day prior to your scheduled appointment, the fee you have paid to secure the booking will be non-refundable.

Helpline Number 0300 999 1800

Community House, South Street, Bromley, Kent BR1 1RH

info@dyslexiawise.co.uk

www.dyslexiawise.co.uk

The Dyslexia Association of Bexley Bromley Greenwich and Lewisham is a local association supporting dyslexics in the community, recognised by the British Dyslexia Assocation.

A company limited by guarantee no. 5725573 - English Charity No. 1114382