Patient Termination Letter

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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]