Western University Cancellations 2024

Thank you for entering your cancellation below.

1. First name *This question is required.

2. Last name *This question is required.

3. Date of appointment TO BE DELETED (mm/dd/yy) *This question is required. This question requires a valid date format of MM/DD/YYYY.

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4. Appointment Time TO BE DELETED *This question is required.

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