Patient Termination Letter

Dr. Lisa Monroe
Monroe Family Practice
123 Health Blvd
Springfield, IL 62704
Phone: (555) 123-4567
Email: ****************
[Date]

Janet Galvan
456 Wellness Drive
Springfield, IL 62711

Dear Ms. Galvan,

I hope this letter finds you well. After careful consideration and thorough review of your medical care needs and our practice’s capabilities, it is with regret that I must inform you of our decision to terminate our patient-provider relationship, effective 30 days from the date of this letter.

This decision is not made lightly. It is based on multiple factors, including the frequent missed appointments and the specialized care needs that fall outside the scope of our practice. It is important for your health care needs to be managed by a provider who can offer the comprehensive and specialized attention you require.

During the 30-day transition period, we will continue to provide emergency care and necessary treatments to avoid any interruption in your care. We strongly recommend you seek a new health care provider who better suits your medical needs. To assist in this transition, we are willing to provide recommendations and facilitate the transfer of your medical records to your new provider, upon receiving a signed release form.

Please contact our office as soon as possible to arrange for the collection of your medical records or to discuss any concerns you may have regarding this transition. Our staff is committed to ensuring a smooth and supportive process for you during this time.

We wish you all the best in your future health care endeavors and hope you find a provider that is better suited to your needs. Thank you for the opportunity to have been of service to you.

Sincerely,

Dr. Lisa Monroe
Monroe Family Practice