Patient Termination Letter No Show

As a professional, your time is valuable. Should a patient miss out on several, exclusively-assigned appointments, then you may have to terminate that patient. Do so using the free to download and easily customized Free Patient Termination Letter No Show template.

[Sender Complete Address]

[Date]

[Name of Patient]
[Complete Address]

Dear [Name of Patient],

This letter is to inform you that I will no longer be your attending physician as of [Date]. This is primarily due to your successive failure to keep several appointments reserved exclusively for you.

I suggest that you find another physician immediately to provide your medical needs. Any delay could jeopardize your health, so I advise you do it as soon as possible.

I will remain available to provide medical services to you, but only on an emergency basis, until you have arranged for another health care in another practice.

Enclosed is a medical records release authorization form for your convenience. I will forward a copy of your medical record upon receipt of your signed authorization.

Respectfully,

[Name and Signature]
[Contact Details]