Dismissal; Unable To Attain Doctor-Patient Relationship

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


Patient Name
City, State  Zip

Dear _____,

I wanted to send a letter reviewing our conversation Wednesday morning.

To treat patients effectively, there must be good communications and trust between the patient and the doctor and staff.   This rapport began to deteriorate in 2012 with the disagreement you had about your bill.  Current misunderstandings about the financial arrangements have made it even more awkward.

This is creating an increasingly strained doctor-patient relationship on my part, and I don’t feel it is proper to treat patients under these circumstances.

We will promptly send records to your new dentist as soon as we receive your signed "Authorization for Release of Records" form..  You may call the local Dental Society for a referral at 555-555-5555, consult the Yellow Pages, or select a dentist that friends or relatives use.

I will, however, be available for emergency treatment until April 1, 2013 so you will have time to see your new dentist.

I encourage you to not wait too long on your treatment since you have active tooth decay, and any delay could result in the decay progressing, requiring more extensive and expensive treatment..



Dr. ______