Medical Referral FormAI Template IconToolbar IconShare Icon

Medical Referral Form

Download our medical referral form (PDF) template to improve your daily workflow and gather patient information cohesively.

Matt Olivares avatar

By Matt Olivares on Nov 17, 2025.

Fact Checked by Gale Alagos.

Use Template

Medical Referral Form Template

Download PDF Template

Commonly asked questions

The form is completed so medical professionals can communicate about the patient's case. This process allows the patients to receive more diversified or specialized care, maximizing their quality of life. Insurance companies also require this if patients want their secondary healthcare practitioner visits covered. They must show proof that they are referred to the specialists by a primary healthcare practitioner rather than visiting them directly.

It is only completed by a doctor. If you are a patient wanting to be referred, talk to your general practitioner or nurse practitioner. When you are being referred from a primary healthcare practitioner to a secondary healthcare practitioner or between specialties, a Medical Referral Form is often required.

The Medical Referral Form is a specific type of healthcare referral form used primarily by medical professionals to refer patients to specialists within the medical field. In contrast, a general healthcare referral form may be used in broader healthcare services, including referrals to allied health professionals like physical therapists, occupational therapists, or mental health providers. While both forms facilitate referrals, the Medical Referral Form focuses more on medical diagnoses and treatments.

EHR and practice management software

Get started for free

*No credit card required

Free

$0/usd

Unlimited clients

Telehealth

1GB of storage

Client portal text

Automated billing and online payments