Dismissal; Repeated No Shows

Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)


Patient Name
Patient Address
City, State  Zip

Mr. Patient,

The last two times that I set aside my time for you, you failed to show up for your appointment.  I cannot keep preparing instruments for your appointment, reserving my time, and have you not keep appointments.  This is unfair for me, and the other patients who are in need of work and could have used your appointment times.

We will mail your records to a new dentist of your request.  I will be available for 30 days for emergency treatment.  Please don’t delay your dental care.  You have many unresolved dental problems that will only get more complicated with time.



Dr. _____