Request Letter for Patient Appointment Cancellation – Sample Letter to Doctor from Patient for Cancellation of Appointment

__________ (Name of the Doctor),
__________ (Address of the Clinic/ Hospital)

Date: __/__/_____ (date)

Subject: Cancellation of appointment for ________

Respected Sir/Madam,

Please find this letter in reference to the patient bearing patient ID number ___________ (patient ID).

I _________ (your name) write this letter in order to cancel the appointment which was scheduled by me for ________ (mention purpose). Respected, this appointment was booked on __/__/____ (date) and scheduled for __/__/____ (date). I beg to inform you that I will not be able to be present for the scheduled appointment, the reason being __________ (mention reason – have to visit out of time/ busy schedule/ any other). I apologize for the disturbance caused.

Therefore, I request you to kindly cancel the scheduled appointment and _______ (mention details – reschedule/refund if applicable/other). I shall be highly obliged for your kind reference.

Date: ___________ (mention date of appointment)
Purpose: ____________ (Purpose)

Thanking you,
___________ (mention your name with signature),
___________ (contact number)

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