Free Patient Termination Letter

Free Download this Patient Termination Letter Design in Word, Google Docs, PDF, Apple Pages, Outlook Format. Easily Editable, Printable, Downloadable.

There can be times when you need to terminate your relationship with your patient. As difficult as it can be, you can at least ensure a proper goodbye with the use of the Free Patient Termination Letter template. Know that this is free to download and is easily editable.

PATIENT TERMINATION LETTER

[DATE]

Dear [RECIPIENT NAME],

I regret to tell you that I will no longer serve as your physician as of [DATE 1]. I must terminate our doctor-patient relationship because of your lack of compliance with our practice’s stated financial protocols.

However, I will still be available to provide you with any treatment that you require, but only for emergency cases, until you have made arrangements with a new healthcare provider.

I advise you to look for another physician immediately so as not to put your health in jeopardy. I have enclosed a medical records release authorization form for your convenience. I will forward a copy of your medical record to your new provider upon receipt of a signed request.

Regards,

[YOUR SIGNATURE]

[YOUR NAME]