Sample Dismissal Letter For Dental Patients

State:
Multi-State
Control #:
US-0138LTR
Format:
Word; 
Rich Text
Instant download

Description

This form is a sample letter in Word format covering the subject matter of the title of the form.

How to fill out Sample Letter For Order Denying Motion To Dismiss?

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FAQ

When a physician decides to dismiss a patient, the patient should be notified in writing. The letter should be printed on office letterhead and sent by first-class mail and by certified mail with a return receipt requested.

Dear (Patient), We have contacted you on several occasions with monthly statements, telephone messages and a personal letter concerning your outstanding balance with our practice. We have determined that due to your noncompliance with our practices' financial policy we must terminate our dentist-patient relationship.

Physicians should send written notice to the patient by certified mail, return receipt requested. The physician should continue to treat the patient until he or she has had a reasonable time to find an alternative source of care.

Dear Patient: The purpose of this letter is to inform you that I can no longer serve as your physician. The reason for this decision is (insert an explanation of the patient's specific actions and the reasons that led up to the decision to end the physician-patient relationship).

This letter is to advise you that I will no longer be available to provide medical services to you after (FUTURE DATE ALLOWING PATIENT REASONABLE TIME TO FIND ANOTHER PHYSICIAN). I will be available to treat you until (DATE FROM ABOVE), so that you will have access to care while you choose another physician.

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Sample Dismissal Letter For Dental Patients