Warning Letter to Uncooperative Orthodontic Patient

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

DATE

Patient Name
Patient Address
City, State  Zip

Dear ___,

Due to an inability to maintain a good doctor-patient relationship, we are dismissing you as a patient at our office.

As explained in the letter you received on ____, we informed you of the minimum cooperation on your part that is required to successfully complete your orthodontic treatment, but you have failed to attain that level of cooperation.

We will be available for the next 30 days, until ____, for emergency treatment only, or to remove all of your orthodontic hardware. After that date, you will no longer be considered a patient here, and must seek dental treatment elsewhere.

You may find a new dentist by checking the phone book yellow pages, by asking friends for referrals, or by calling our local dental society at ___-___-____.

Sincerely,

Dr. ___