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To Patient Termination Letter

Write this type of letter to notify a patient that something is being terminated. For example, if you are a medical office, you might write this letter to a patient to inform him or her that you will be terminating your doctor-patient relationship with him or her. You will likely need to modify this letter sample at least somewhat so that it most closely matches what you want to communicate. Include in your letter any pertinent details.

[Your letterhead, if desired; if not, your return address]

[Date of letter-month, day, and year]

[Recipient's first and last names]
[Company name]
[Street or P.O. box address]
[City, State ZIP code]

Dear [recipient's name]:

We are writing to notify you that effective immediately, our medical office will be terminating our professional relationship with you as our patient. We regret that we must make this decision, but this is necessary as a result of your repeated noncompliance with our medical instructions over recent weeks.

Our billing office will send to you a final bill for services provided by our office. Please notify us if you need to obtain a copy of your medical records from our office, and we will provide instructions on doing that. Also contact us if you have any questions about this termination. Thank you for your attention to this important matter.

Sincerely,

 

[Signature]

[Sender's first and last names]

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