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

• Category: Letters - Nonlegal - Termination
• State: Multi-State
• County: Dallas
• 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] Subject: Termination of Physician's Care — Patient to Physician Dear Dr. [Physician's Last Name], I hope this letter finds you well. As your patient for [duration], I wanted to inform you that I have made the difficult decision to terminate my medical care under your guidance. This decision was not made lightly, and I believe it is in my best interest to seek medical assistance from another healthcare provider. [Optional: Explain your reasons for termination. For example, dissatisfaction with the treatment plan, lack of improvement, or issues with communication.] Over the course of our doctor-patient relationship, I appreciate the quality of care you have provided to me. However, after careful consideration and discussion with my loved ones, I firmly believe that I would benefit from exploring alternative medical treatments or seeking a second opinion. This is not a reflection of your abilities as a physician, but rather a personal choice to explore other options. I kindly request that you transfer my medical records, including test results, physician notes, and any other relevant documents, to the new healthcare provider I will be selecting. It is essential for the continuity of my care that all necessary medical information is promptly forwarded to the following healthcare professional: [New Physician's Name] [New Physician's Address] [City, State, ZIP] [Phone Number] I would appreciate it if you could arrange for the transfer of my medical records in a timely manner, ensuring that they reach the new healthcare provider before my scheduled appointment on [date]. In case there are any charges associated with the transfer of records, please inform me in advance. In closing, I would like to express my sincerest gratitude for the medical care you have provided to me during our time together. Although our patient-physician relationship is coming to an end, I will always remember the kindness, compassion, and professionalism you demonstrated throughout our interactions. Thank you for your understanding and cooperation in this matter. Should you require any further information or have any questions, please feel free to contact me using the details provided above. Wishing you continued success in your medical practice, [Your Name]

[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, ZIP] Subject: Termination of Physician's Care — Patient to Physician Dear Dr. [Physician's Last Name], I hope this letter finds you well. As your patient for [duration], I wanted to inform you that I have made the difficult decision to terminate my medical care under your guidance. This decision was not made lightly, and I believe it is in my best interest to seek medical assistance from another healthcare provider. [Optional: Explain your reasons for termination. For example, dissatisfaction with the treatment plan, lack of improvement, or issues with communication.] Over the course of our doctor-patient relationship, I appreciate the quality of care you have provided to me. However, after careful consideration and discussion with my loved ones, I firmly believe that I would benefit from exploring alternative medical treatments or seeking a second opinion. This is not a reflection of your abilities as a physician, but rather a personal choice to explore other options. I kindly request that you transfer my medical records, including test results, physician notes, and any other relevant documents, to the new healthcare provider I will be selecting. It is essential for the continuity of my care that all necessary medical information is promptly forwarded to the following healthcare professional: [New Physician's Name] [New Physician's Address] [City, State, ZIP] [Phone Number] I would appreciate it if you could arrange for the transfer of my medical records in a timely manner, ensuring that they reach the new healthcare provider before my scheduled appointment on [date]. In case there are any charges associated with the transfer of records, please inform me in advance. In closing, I would like to express my sincerest gratitude for the medical care you have provided to me during our time together. Although our patient-physician relationship is coming to an end, I will always remember the kindness, compassion, and professionalism you demonstrated throughout our interactions. Thank you for your understanding and cooperation in this matter. Should you require any further information or have any questions, please feel free to contact me using the details provided above. Wishing you continued success in your medical practice, [Your Name]