Subject: Termination of Physician's Care — Patient to Physician [Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, ZIP] Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to inform you about my decision to terminate our doctor-patient relationship effective [termination date]. First and foremost, I would like to express my gratitude for the medical care and attention you have provided me throughout the duration of our association. Your expertise and dedication have been invaluable in managing my healthcare needs. However, after careful consideration and discussions with my family, I have decided to pursue medical care elsewhere in the best interest of my health and well-being. This decision in no way reflects any dissatisfaction with the quality of your services or the level of care received. Having considered various factors, such as convenience, access to specialized treatments, and the opportunity to explore alternative healthcare options, I believe it is in my best interest to transition to a different medical provider who meets my current needs adequately. I kindly request that you arrange for the transfer of my medical records to my new healthcare provider as soon as possible. Additionally, I would appreciate any assistance you can offer in facilitating the seamless transfer of my ongoing treatments, prescriptions, and any pertinent medical information deemed necessary for continuation of care. Please be assured that this decision was not taken lightly, and I understand the importance of maintaining continuity of care. Therefore, I request your assistance in making this transition as smooth as possible. Should you require any further information or need my assistance in facilitating the transfer of medical records, please do not hesitate to contact me at the provided contact details. Once again, I would like to express my utmost appreciation for the medical care you have provided to me. I truly value the professional relationship we developed over time and appreciate your understanding and support regarding my decision to seek medical care elsewhere. Thank you for your attention to this matter, and I wish you the best in your future endeavors. Sincerely, [Your Name]
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.