- = Forms : The Leeds Teaching Hospital

Your operation date

Please complete the form below to accept or decline the date for your operation. Please note that all fields are mandatory.

Please tell us who is completing this form

Your details

Patient to enter the following details

Your operation

These details can be found in your letter

Are you accepting your date
for admission?

Human verification

To combat spam and ensure only valid details are provided please enter the verification code below


CAPTCHA