Dismissal Due To Repeated No Shows and Cancellations

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


Patient Name
City, State  Zip

Dear Mr. ______:

We try very hard to maintain our schedule so that all our patients can be treated  promptly.  Needless to say, canceling with short notice, showing up late, or simply not showing up is very disruptive for our schedule and unfair for our other patients who value prompt treatment.

It has been brought to my attention that out of the past 9 appointments you have scheduled, you failed to show up for 2 of them, cancelled 3 with very short notice, and came late for one.

I am sorry our office has failed to meet your scheduling needs.  We will gladly forward copies of your records to another dental office as soon as you have returned the release authorization form.  I will be available for 30 days for your emergency dental treatment only.



Dr. ______