West Virginia 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 Code] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, Zip Code] Subject: Termination of Physician's Care — Patient to Physician Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to inform you of my decision to terminate my physician-patient relationship with you. After careful consideration, I believe it is in my best interest to seek medical care from another healthcare provider. I would like to express my gratitude for the care and attention you have provided to me over the course of our professional relationship. Your expertise and guidance have been valuable, and I am thankful for the time and effort you have dedicated to my health. However, I believe it is essential for me to explore other medical options and receive a fresh perspective on my health concerns. This decision is not a reflection of dissatisfaction with your services or capabilities as a physician. It is simply a personal choice driven by a desire for a different approach to my ongoing healthcare needs. To ensure a smooth transition, I kindly request that you provide me with copies of my medical records, including but not limited to: — Doctor's notes from previous appointments — Lab test result— - X-ray and imaging reports — Surgical and hospitalization record— - Prescription history This information will assist in maintaining continuity of care and enable my new healthcare provider to get a better understanding of my medical history. Furthermore, I would appreciate it if you could refer me to potential healthcare providers who may align better with my current needs and preferences. Your professional guidance in identifying suitable alternatives would be greatly appreciated. Please consider this letter as my official notice of termination of our physician-patient relationship. I would be grateful if you could confirm receipt of this letter in writing. Also, kindly let me know the appropriate procedure to complete the process of transferring my medical records and settling any outstanding bills. Thank you once again for your medical care and attention throughout our association. I genuinely appreciate your understanding and cooperation in this matter. Should you need any additional information or require any further details, please do not hesitate to contact me at your convenience. Wishing you continued success in your medical practice. Sincerely, [Your Name]

[Your Name] [Your Address] [City, State, Zip Code] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, Zip Code] Subject: Termination of Physician's Care — Patient to Physician Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to inform you of my decision to terminate my physician-patient relationship with you. After careful consideration, I believe it is in my best interest to seek medical care from another healthcare provider. I would like to express my gratitude for the care and attention you have provided to me over the course of our professional relationship. Your expertise and guidance have been valuable, and I am thankful for the time and effort you have dedicated to my health. However, I believe it is essential for me to explore other medical options and receive a fresh perspective on my health concerns. This decision is not a reflection of dissatisfaction with your services or capabilities as a physician. It is simply a personal choice driven by a desire for a different approach to my ongoing healthcare needs. To ensure a smooth transition, I kindly request that you provide me with copies of my medical records, including but not limited to: — Doctor's notes from previous appointments — Lab test result— - X-ray and imaging reports — Surgical and hospitalization record— - Prescription history This information will assist in maintaining continuity of care and enable my new healthcare provider to get a better understanding of my medical history. Furthermore, I would appreciate it if you could refer me to potential healthcare providers who may align better with my current needs and preferences. Your professional guidance in identifying suitable alternatives would be greatly appreciated. Please consider this letter as my official notice of termination of our physician-patient relationship. I would be grateful if you could confirm receipt of this letter in writing. Also, kindly let me know the appropriate procedure to complete the process of transferring my medical records and settling any outstanding bills. Thank you once again for your medical care and attention throughout our association. I genuinely appreciate your understanding and cooperation in this matter. Should you need any additional information or require any further details, please do not hesitate to contact me at your convenience. Wishing you continued success in your medical practice. Sincerely, [Your Name]