__________ (Name of the Doctor),
__________ (Address of the Clinic/ Hospital)
Date: __/__/_____ (date)
Subject: Cancellation of appointment for ________
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)
___________ (mention your name with signature),
___________ (contact number)