---
title: Appointment request form template, free
description: A free appointment request form template. Request an appointment: the service, preferred dates and times, how to reach you and anything to prepare. Publish it as one link; every response is its own signed copy.
---

# Appointment request

Request an appointment: the service, preferred dates and times, how to reach you and anything to prepare.

Collect appointment requests with real choices, then confirm a time.

## About you

- Full name (text)
- Email (email)
- Phone (phone, optional)

## Your appointment

- Service or reason (text)
- First choice of date (text)
- Second choice of date (text, optional)
- Preferred time (choice)
- In person or online (choice)
- Notes (text, optional)

## Before your visit

- I will let you know as soon as I can if I need to change or cancel. (tick box)
- I understand that what I enter here is stored by the organisation that published this form and used only for the purpose (tick box)

## Signature

- Visitor signature (signature)
- Visitor date signed (date signed)