Doctor Referral Form Template

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Available on a Paid Plan

Add this doctor referral form template to your website with 123FormBuilder. Edit the template with simple drag & drop, no coding skills needed.

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About this template

Doctors can use the doctor referral form template to securely and easily refer patients to a more specialized medical practitioner in the patient’s type of condition. With our doctor referral form template, you have a safe solution to transfer sensitive medical information, remain HIPAA compliant, and follow data privacy regulations. Customize this doctor referral form as you need it for your medical practice using our form builder.

Frequently Asked Questions

What are doctor referrals?

A doctor referral is a document written by the current doctor who refers the patient to see another specialist that is more prepared in that area of expertise.

How do you write a letter of referral to a doctor?

A letter of referral to a doctor should include information about the patient, their current medical condition, first diagnosis, medical history, the reason for referring them to another doctor, the recommended specialist or clinic, and all parties’ contact details. Although it’s called a letter of referral, it can be structured into an online form, which gives it a more organized way of collecting, revising, and storing data.

Customize template

Use this doctor referral form in your practice to collect patient and referring doctor details, such as contact info, medical history, and even digital signatures. Of course, once you’ve copied this pre-made template into your 123FormBuilder account, there’s no limit to what you can add to it. Use the drag and drop to add more fields, upload your logo, change the form theme and configure multiple email recipients.

Publish template

After retouching the content and appearance of your doctor referral form, you’ll want it made available for fellow healthcare practitioners. To this end, you only need to copy and paste the form code to embed it on a web page. Alternatively, the form link travels well on email or other web platforms – our system provides you with many options to choose from. Furthermore, with the mobile responsive form design, the doctor referral form will look good on any screen size.

Collect & manage data

Every doctor referral you receive lands in a secure database. We take data protection seriously, and you can even get HIPAA compliance on your forms with just a few clicks. Analyze and update your data table directly in the 123FormBuilder dashboard or export it to Excel, CSV or PDF. In addition, if you like using a file management app to enhance record-keeping, make sure you check out our multiple third-party integrations.

Optimize processes

Simplify patient record-keeping with online forms that do so much more than just accumulate information. With 12FormBuilder it’s easy to configure just the medical form you need, without having to write any code. Besides, with instant email or SMS alerts each time a new submission comes in, you’ll save precious time.

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