Patient Termination Letter Templates and Guidelines
Sending a letter is one way to start the process of discharging a patient for their problematic behavior. As a professional, your time is valuable, and maintaining a respectful environment is essential for providing care.
Termination Due to Problematic Behavior
I do not like to terminate patients. However, you have been rude and disrespectful to me and to my staff. We find it hard to deliver the care you need when you are constantly displaying such demeanor. Check out our Free Patient Termination Letter Due To Behavior Template to help you get started. It already has ready-made written content that can guide you in the write-up of your letter.
The template provides a structured format including:
- [DATE]
- [RECIPIENT NAME]
- [DETAIL] regarding the behavior
- [YOUR NAME] and signature
Termination Due to No-Show Appointments
Should a patient miss out on several, exclusively-assigned appointments, then you may have to terminate that patient. This is primarily due to your successive failure to keep several appointments reserved exclusively for you. Do so using the free to download and easily customized Free Patient Termination Letter No Show template.
It is important to inform the patient: "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."
Continuity of Care and Medical Records
During the transition period, professional obligations remain. Between this date and the date of this letter, I will still be able to provide you with emergency care as you require until you can find another practice to provide you with the treatment you need. 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.
Regarding documentation, I will send a copy of your medical record to your new provider upon receipt of a signed request. 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.
Available Template Formats
Download this Patient Termination Letter Design in various formats. These are easily editable, printable, and downloadable:
- Microsoft Word
- Google Docs
- Apple Pages
- Outlook Format
| Termination Reason | Primary Justification |
| Behavior | Rude and disrespectful demeanor to staff |
| No Show | Successive failure to keep several appointments |