[FREE] 11 Collection Letter Examples for Dental Offices

A collection letter is an attempt to encourage patients to clear their outstanding dues. It serves as a humble reminder to the patient without breaking the relationship of dentist and the patient. A good letter combined with a superior patient communications strategy will help your dental office improve collections and keep bad debt down. In this article we present 5 dental collection letter templates you can send to your patients. Just cut, paste, fill in your information and send.

dental collection letter sample

Letter courtesy of Dentists Collect.

[Your Name] [Street Address] [City, ST ZIP Code] December 16, 2015

[Patient Name] [Street Address] [City, ST ZIP Code]

Dear [Patient Name]:

You have a past-due balance of $323.46 for dental services provided. As of December 16, 2015, we have not received your payment.

If you are having financial difficulties, please call our office during business hours to make confidential payment arrangements.

If you have questions about the amount your insurance company covers, please call their customer service number to discuss.

If you have already sent your payment, please disregard this notice and accept our thanks.

[Your Practice Name] [Title]

Letter courtesy of Pediatric Inc.

«Recip_FirstName» «Recip_LastName»
«Recip_Address1» «Recip_Address2»
«Recip_City» «Recip_State» «Recip_Zip»
«Patient_FirstName» Account # «Patient_AcctNo»

Dear Mr/Mrs. «Recip_LastName»

It’s our policy to contact patients who received a billing statement from us in the past 30 days, but have not responded.

You currently have a balance of $ «Patient_PatBalance» with «Patient_ProviderName» To date we have not received payment or have heard from you regarding payment arrangements.

We understand that many of our patients experience financial difficulties. If this is the case, please let us know so we can assist you in making budget payment arrangements. We want to help you fulfill your commitment without causing undue hardship, so please do not hesitate to contact our office.

If you have already sent payment in, then please, disregard this letter. Otherwise, we look forward to receiving your payment within five days of this letter. Your prompt attention is appreciated.


[Your Practice Name] [Title]

15-Day Patient Collection Letter courtesy of Physicians Practice.



Patient Name

Patient Address

Re: Patient Name

Account #:

Balance Due: $

Dear [Patient Name],

This is to notify you that your account with us is delinquent. We have not received a response to the statements that were sent to you. The patient balance noted above is the amount that is your responsibility after your insurance company has made payments.

We must receive your payment within 15 days from the date of this letter, to avoid further collection action.

If you need assistance or have any questions, please call between the hours of 8 a.m. and 5 p.m. If you are unable to pay this bill in full, please call and we can discuss setting up a payment plan.


[Your Practice Name]

Letter courtesy of Dental Economics.

Dear [Insert Patient Name],

The statements you have received from us indicate a remaining balance of $xxxx for the dentistry we recently completed. We did your dentistry in good faith that we would receive compensation for the work that we performed.

We want to work with you to clear this balance as soon as possible, so please call our office and ask to speak with [Insert Coordinator Name], our financial coordinator at (123) 456-7890. She will be happy to work out some suitable financial arrangements with you.

If we do not hear from you within the next 10 days, our only option is to turn your account over to a collection agency. We hope this will not be necessary.

[Insert Dentist’s name]

Letter courtesy of Letters Free.

Dear [Patient Name],

This is to inform you that you are required to settle the due payment of $000 for the dental services provided by [Your Practice Name] in between [Start Date] to [End Date].

As per our record you have not made the payment even after our telephonic reminder on [Reminder Date]. You are requested to contact our clinic if you have any financial difficulties regarding the amount. We will definitely arrange some assistance in form of flexible payment structure.

If this payment comes under your insurance company, you are requested to contact their officer to discuss and settle the outstanding amount promptly.

If you have already sent your payment before receiving this letter of collection, please take no notice of this and accept our sincere thanks.

[Your Practice Name] [Title]

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