Guam Sample Letter for Termination of Physician's Care - Patient to Physician

• Category: Letters - Nonlegal - Termination
• State: Multi-State
• Control #: US-0237LR
• Format: Word; Rich Text

Description

This form is a sample letter in Word format covering the subject matter of the title of the form. [Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Physician’s Name] [Doctor's Office Name] [Address] [City, State, ZIP] Subject: Termination of Physician's Care Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to inform you of my decision to terminate our physician-patient relationship effective immediately. Due to various reasons, I believe it is in my best interest to seek medical care from another healthcare provider at this time. I want to express my gratitude for the care and attention you have provided during our time working together. Your expertise, professionalism, and dedication to my well-being have been greatly appreciated. However, I have decided to explore alternative treatment options, which align more closely with my current health concerns and preferences. While it was not an easy decision to make, I firmly believe that patient autonomy and the ability to actively participate in decision-making are essential components of any medical treatment plan. In light of this, I have carefully considered my healthcare needs and have decided to explore different approaches to address my medical conditions. I kindly request that you transfer my medical records, including all relevant documentation, test results, and treatment details, to the following healthcare provider: [New Physician's Name] [Doctor's Office Name] [Address] [City, State, ZIP] Additionally, I would appreciate it if you could provide me with a referral if necessary and any essential information that may assist in the continuity of my care during this transition. Rest assured that this decision does not reflect any dissatisfaction with your services or the care you have provided thus far. I understand that healthcare is a collaborative effort, and I sincerely thank you for your expertise and dedication to my well-being. Your assistance in facilitating a smooth transition of my medical records and any necessary information would be greatly appreciated. I kindly request a written confirmation acknowledging the receipt of this letter and the subsequent actions taken. Should you require any additional information or have any questions, please do not hesitate to contact me using the provided contact details. Thank you again for your support and understanding. Yours sincerely, [Your Name]

[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Physician’s Name] [Doctor's Office Name] [Address] [City, State, ZIP] Subject: Termination of Physician's Care Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to inform you of my decision to terminate our physician-patient relationship effective immediately. Due to various reasons, I believe it is in my best interest to seek medical care from another healthcare provider at this time. I want to express my gratitude for the care and attention you have provided during our time working together. Your expertise, professionalism, and dedication to my well-being have been greatly appreciated. However, I have decided to explore alternative treatment options, which align more closely with my current health concerns and preferences. While it was not an easy decision to make, I firmly believe that patient autonomy and the ability to actively participate in decision-making are essential components of any medical treatment plan. In light of this, I have carefully considered my healthcare needs and have decided to explore different approaches to address my medical conditions. I kindly request that you transfer my medical records, including all relevant documentation, test results, and treatment details, to the following healthcare provider: [New Physician's Name] [Doctor's Office Name] [Address] [City, State, ZIP] Additionally, I would appreciate it if you could provide me with a referral if necessary and any essential information that may assist in the continuity of my care during this transition. Rest assured that this decision does not reflect any dissatisfaction with your services or the care you have provided thus far. I understand that healthcare is a collaborative effort, and I sincerely thank you for your expertise and dedication to my well-being. Your assistance in facilitating a smooth transition of my medical records and any necessary information would be greatly appreciated. I kindly request a written confirmation acknowledging the receipt of this letter and the subsequent actions taken. Should you require any additional information or have any questions, please do not hesitate to contact me using the provided contact details. Thank you again for your support and understanding. Yours sincerely, [Your Name]