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Sample Employee Exit Interview Form

September 15, 2022

It is always a good idea to conduct an employee exit interview interview with any employee who severs ties with your healthcare practice. You should offer the option, and if the terminated employee refuses, make notes in the employee file that an interview was denied and no reasons for termination was provided.  If the employee has provided reasons for terminating but refuses to conduct the interview and sign the document, you may fill out the pertinent portions on this form and note that the employee refused to sign.  

Disclaimer: This document is only intended for educational purposes and does not contain legal advice.  By downloading this document, you will not establish any attorney-client relationship with Perla or its affiliates and agree to waive any liabilities or damages arising from the download or the use of this form. You must discuss any employment issues with a qualified employment lawyer who is familiar with healthcare employment issues. To find an employment healthcare attorney, you may search Perla’s network of healthcare advisors by clicking below.

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Reza Ghafoorian, MD, JD

Perla, Inc.

Perla is the first B2B matching service that connects healthcare businesses and healthcare professionals to vetted, trusted advisors and consultants with experience in the healthcare industry. At Perla, we screen advisors using a multistep process that checks licensing, insurance, client reviews, registrations, and more.

Sample Employee Exit Interview Form

Use this Form to conduct an employee exit interview interview with any employee who severs ties with your healthcare practice.

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