South Dakota 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] [Physician's Address] [City, State, Zip] Dear Dr. [Physician's Last Name], I am writing to inform you that I have made the difficult decision to terminate our physician-patient relationship effective immediately. While this decision comes with careful consideration, I feel it is in my best interest to seek medical care elsewhere. I would like to express my gratitude for the care you have provided me during our time together. However, I believe it is time for me to explore other options and discover a physician who may better suit my needs and personal preferences. I kindly request that you prepare my medical records and any relevant documents for transfer to my new healthcare provider. Please ensure that this transfer is completed promptly, as it is crucial for the continuity of my medical care. I would appreciate it if you could forward the records directly to [new physician's name and address] at your earliest convenience. To ease the transition process, I kindly ask for your assistance in providing any necessary prescriptions or referrals that may be required during this interim period until I establish care with my new physician. I acknowledge that any financial obligations resulting from the termination of our relationship will be properly settled. Please inform me of any outstanding bills or administrative procedures that need to be addressed. Again, I genuinely appreciate the medical care provided by you and your staff. Although I have chosen to pursue a different physician-patient relationship, I respect your expertise and dedication to your patients. Should circumstances change in the future, I will not hesitate to consider returning to your care. Thank you for your understanding and assistance in facilitating this transition. I wish you continued success in your practice. Sincerely, [Your Name]

[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 am writing to inform you that I have made the difficult decision to terminate our physician-patient relationship effective immediately. While this decision comes with careful consideration, I feel it is in my best interest to seek medical care elsewhere. I would like to express my gratitude for the care you have provided me during our time together. However, I believe it is time for me to explore other options and discover a physician who may better suit my needs and personal preferences. I kindly request that you prepare my medical records and any relevant documents for transfer to my new healthcare provider. Please ensure that this transfer is completed promptly, as it is crucial for the continuity of my medical care. I would appreciate it if you could forward the records directly to [new physician's name and address] at your earliest convenience. To ease the transition process, I kindly ask for your assistance in providing any necessary prescriptions or referrals that may be required during this interim period until I establish care with my new physician. I acknowledge that any financial obligations resulting from the termination of our relationship will be properly settled. Please inform me of any outstanding bills or administrative procedures that need to be addressed. Again, I genuinely appreciate the medical care provided by you and your staff. Although I have chosen to pursue a different physician-patient relationship, I respect your expertise and dedication to your patients. Should circumstances change in the future, I will not hesitate to consider returning to your care. Thank you for your understanding and assistance in facilitating this transition. I wish you continued success in your practice. Sincerely, [Your Name]