These forms are intended as samples only. Seek legal advice from a competent attorney in your own state prior to utilizing these forms. The SCPIE Companies hereby disclaim any and all liability resulting from your use of these forms and/or their effectiveness.

• Refusal to Permit Medical Treatment [1 page] (PDF)
• Patient Termination Letter for Noncompliance [1 page]
• Patient Termination Letter for Noncompliance – Managed Care [1 page]
• Patient Termination Letter for Communication Difficulties [1 page]
• Patient Termination Letter for Nonpayment of Bills [1 page]