[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-281457-105":53,"doc-detail-281457-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","sample-patient-termination-letters-general-overdue-account","Sample Patient Termination Letters - General - Overdue Account","","Dentists can use these templates to notify patients that the dentist-patient relationship is being ended without stating an unsupported reason, while still honoring legal compliance requirements. The letters set a 30-day effective date, outline any additional treatment needs, and provide guidance for emergency access. They also recommend finding a new dentist, explain access to records and x-rays through a written request, and include an authorization form. Separate wording addresses general termination and termination due to overdue accounts.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/sample-patient-termination-letters-general-overdue-account/281457/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/sample-patient-termination-letters-general-overdue-account/281457.png","ImageObject",442,249,{"name":88,"@type":89},"Blitz","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-19","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"When does the termination of the dentist-patient relationship become effective?","Question",{"text":109,"@type":110},"Both templates state the relationship termination is effective 30 days from the date of the letter.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What must be included regarding additional treatment needs?",{"text":114,"@type":110},"The letters require describing any additional treatment needs as of today and noting that failure to seek care may worsen oral health, or using the provided statement if there are no additional needs.",{"name":116,"@type":107,"acceptedAnswer":117},"How can a patient obtain copies of dental records and x-rays?",{"text":118,"@type":110},"The dentist will provide a free copy upon receipt of a signed, written request, and the letter references an enclosed authorization form and the need to indicate the receiving dentist’s name and address.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},281457,1790107428,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":73},24464137899374,"https://us-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Sample Patient Termination Letter – General  \nDentists may find themselves with a desire to terminate a patient from their care without having – or wishing to state – a specific reason for the termination. The reason may be a “bad feeling” about an individual, a patient’s general negative demeanor, or something that is challenging to describe. Many states do not require a dentist to have a specific reason for terminating a dentist-patient relationship.(Check your state’s rules.) However, the termination cannot be based on criteria that would violate federal, state, or local laws. This sample letter satisfies the requirements of patient notification for termination of the dentist-patient relationship without stating a specific reason.  \nCOPY THE TEXT BELOW ONTO YOUR DENTAL OFFICE LETTERHEAD  \n[Date]  \n[Patient Name]  \n[Street Address]  \n[City, State ZIP]  \nVia email, Certified Mail, Return Receipt Requested and First-Class Mail  \nDear [Patient name],  \nAfter careful consideration, I am writing to inform you that I am ending our dentist-patient relationship and withdrawing from your care. The termination of our relationship will be effective 30 days from the date of this letter.  \nAs of today, our records indicate your additional treatment needs are: [state what treatment needs to be done; elaborate about current problems/issues/concerns]. It is important that you seek care to address these needs, as failure to do so will result in a worsening of your oral health. [If there are no additional treatment needs, use this statement: As of today, our records indicate you have no additional treatment needs beyond routine periodic exams and cleanings.]  \nI am available to see you for any dental emergency you may have within 30 days from the date of this letter. However, you must first call my office to schedule an emergency appointment if such a situation arises.  \nI recommend that you find a new dentist as soon as possible to continue your dental care. You may find another dentist by contacting the [local or state dental association] or your dental insurance plan administrator, or by obtaining a referral from family or friends. You can also perform an internet search for other dentists in our community.  \nI will provide a free copy of your dental records and x-rays upon receipt of a signed, written request from you. For your convenience, I have enclosed an authorization form you may use for that request. Please be sure to indicate the name and address of the dentist you want to receive your records.  \nI wish you well with your future dental care.  \nSincerely,  \n[Doctor’s Name]  \nProfessional Protector Plan® is a registered service mark ofB & B Protector Plans, Inc., National Administrator, Tampa, FL, a wholly-owned subsidiary of Brown & Brown, Inc. Coverage under the Professional Protector Plan® may not be available in all states, and coverage availability is always subject to underwriting review and approval. The information contained herein is intended to be for general informational purposes only. Nothing contained herein is, nor is intended to be, legal or dental advice. Professional Protector Plan® makes no representations regarding the correctness or completeness of this information and are not liable for any loss or damages that may be alleged to result from its use. We also are under no obligation to update this material. This is not an insurance policy. Document version: April 2025.  \nSample Patient Termination Letter – Overdue Account  \nNonpayment of fees is one of the most common reasons dentists choose to terminate a doctor-patient relationship. Fees and balances should ideally be discussed well before a collection action or termination is considered. Neither a patient’s nonpayment nor your collection action changes the dentist-patient relationship. If you desire to end it, you must properly notify the patient.  \nCOPY THE TEXT BELOW ONTO YOUR DENTAL OFFICE LETTERHEAD  \n[Date]  \n[Patient Name]  \n[Street Address]  \n[City, Sta","cbCaiqxjEkP6IWTG","https://ap.wps.com/l/cbCaiqxjEkP6IWTG","pdf",963194,6,"English","# Sample Patient Termination Letter\n## General\n## Overdue Account","[{\"question\":\"When does the termination of the dentist-patient relationship become effective?\",\"answer\":\"Both templates state the relationship termination is effective 30 days from the date of the letter.\"},{\"question\":\"What must be included regarding additional treatment needs?\",\"answer\":\"The letters require describing any additional treatment needs as of today and noting that failure to seek care may worsen oral health, or using the provided statement if there are no additional needs.\"},{\"question\":\"How can a patient obtain copies of dental records and x-rays?\",\"answer\":\"The dentist will provide a free copy upon receipt of a signed, written request, and the letter references an enclosed authorization form and the need to indicate the receiving dentist’s name and address.\"}]","Sample Patient Termination Letters - General - Overdue Account | PDF",1789566279]