Subject: Termination of Physician's Care — Patient to Physician Dear [Physician's Name], I hope this letter finds you well. I am writing to formally terminate our physician-patient relationship effective immediately. As my primary healthcare provider, I believe it is essential to communicate my decision clearly and respectfully. Throughout our time working together, I have sincerely appreciated your dedication and commitment in providing me with the best possible care. However, after careful consideration, I have made the difficult decision to seek medical assistance elsewhere. I believe this change will be in the best interest of my health and well-being. This decision is not a reflection of your expertise or the quality of care you have provided me. Instead, it is driven by personal factors that have led me to reevaluate my healthcare needs. Please understand that this has not been an easy decision for me to make. I would like to express my gratitude for the medical attention you have given me during our time working together. Your professionalism and compassion have not gone unnoticed, and I am genuinely thankful for the time and effort you have dedicated to my care. In light of terminating our physician-patient relationship, I kindly request the following: 1. Provide me with a copy of my medical records, including any relevant tests, diagnoses, and treatments received while under your care. 2. If possible, recommend another healthcare professional or clinic where I can transfer my medical care seamlessly. Your guidance will be invaluable in ensuring continuity of care during this transitional period. 3. Please confirm in writing that you have received this letter and acknowledge the termination of our physician-patient relationship. Once again, I want to emphasize my deepest respect, and thanks for the care you have provided me. This decision was not made lightly, and I sincerely hope you understand my reasons for choosing this course of action. I look forward to receiving the requested documentation and recommendations in due course. If you require any additional information or have any questions, please do not hesitate to contact me at [phone number] or [email address]. Thank you for your understanding, and I wish you continued success in your practice. Sincerely, [Your Name] --- Alternate versions of King Washington Sample Letter for Termination of Physician's Care — Patient to Physician: 1. King Washington Sample Letter for Termination of Specialist's Care — Patient to Physician 2. King Washington Sample Letter for Termination of Pediatrician's Care — Parent to Physician 3. King Washington Sample Letter for Termination of Psychologist's Care — Patient to Therapist 4. King Washington Sample Letter for Termination of Dentist's Care — Patient to Dental Provider 5. King Washington Sample Letter for Termination of Oncologist's Care — PatienphysicianAnAnAnAnan.an
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.