Sample
[DATE, ex. Wednesday, June 11, 2006]
NAME,AND ADDRESS, ex.
Robert Brown
1234 First Street
Suite 567
Anycity, Anystate 85245]
Dear [NAME, ex. Robert Brown],
You did not show up for your appointment on [DATE & TIME, ex. Wednesday, 2:30 PM].
Regretfully, we must charge a cancellation fee of [AMOUNT OF CANCELLATION FEE, ex. $15]. We enclose an invoice in this regard.
Kindly contact our office in order that we can reschedule the appointment.
Sincerely,
[YOUR NAME]