Dismissal Due To Repeaded No Shows

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


Patient Name
Patient Address
City, State  Zip

Dear Jane,

I noticed that you missed your 1 ½-hour appointment today, and that you have missed three other scheduled appointments with us in the past.   I’m sorry our schedule has not worked well with your schedule.  We cannot, however, continue to reserve time for you and have it disregarded.

Our office will be available to you for 30 days  for emergency treatment only; after 30 days we will no longer schedule appointments for you.  This will give you adequate time to find another dental office.

We will gladly forward x-rays/records to your next dentist as soon as you sign and return the enclosed authorization with their name and address.



Dr. ______