Signed Date
Date
OoLi Orthodontics Location
OoLi Orthodontist Name
Patient Name
Patient Address
Patient Email
Patient Phone
Person Responsible for Patient's Orthodontic Treatment
Parent / Guardian Name
Parent / Guardian Email
Parent / Guardian Phone
Termination of Treatment Date
This letter is to inform you that as of above Termination of Treatment Date, Won-Woo Park, D.M.D., M.S. of OoLi Orthodontics will be terminating orthodontic care of above named patient. I am withdrawing from further orthodontic care to above named patient due to lack of patient cooperation (frequent & prolonged missed appointments). This letter is a follow up of the previous Notice of Continued Missed Appointment letter. I am taking this action as a result of the multiple and continued missed appointments.
Please be advised that above named patient's treatment is not complete. I urge you to immediately find and seek treatment from another orthodontist. Further delay in treatment will prolong length of orthodontic treatment and may potentially contribute to dental health problems. These problems include loss of tooth enamel, increased risk of cavities and gum disease, and the possibility of injury to the mouth from loose or broken appliances. I will assist in locating an orthodontist if you desire.
If above named patient has decided to discontinue with orthodontic treatment, I recommend that you make an appointment to have the orthodontic appliances removed. I will be available to attend to above named patient’s orthodontic care for only emergencies until above Termination of Treatment Date.
I regret having to take this action.
Sincerely,
W.W. Jonathan Park, DMD, MS
