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10 Medical Referral Forms to Help You Reach More Patients

Posted on May 6, 2022

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10 Medical Referral Forms to Help You Reach More Patients

Healthcare providers use referrals when a diagnosis or treatment falls outside their area of expertise. However, managing referrals can be a headache if you don’t have the right systems and documentation in place. 

Luckily for you, we’ve got just the solution.

In this article, we’ll share our top 10 medical referral forms to help you simplify your operational workflows and ensure patients get the best medical services possible. 

Let’s get to it.

1. Dental Referral Form

dental referral form

Who needs this? 

This dental referral form is made for dentists and oral care practitioners to refer a patient to a specialized dental professional. Dentists can use this form to transfer patients for treatment or further consultation based on their diagnosis. 

What’s it for? 

This form allows dental practitioners to share their diagnosis for a patient with another specialist. It contains relevant fields to include the patient’s personal details, the referring doctor’s diagnosis, and any dental records.

Key benefits:

  • Automated notifications: easily notify any relevant parties—such as the specialist you’re referring your patient to—when forms are completed.
  • Conditional logic flow: adapt the form depending on previous input about the patient’s condition and needs.
  • Highly customizable: build referral forms that work for your dental practice and referral process.

2. Doctor Referral Form

doctor referral form

Who needs this? 

This doctor referral form allows medical staff such as doctors and nurses,  to refer a patient to a specialist practitioner when they can’t offer the required service. 

It’s an extensive form containing a complete record of the patient’s symptoms, past diagnoses, and the doctor’s reasons for making the referral.

What’s it for? 

This is one of the most common patient referral forms that healthcare professionals use to transfer patients to a more specialized doctor. It includes the original diagnosis and suggestions for the next steps in the treatment. 

Key benefits:

  • Integration capabilities: safely collect and store all the data in your preferred tools with ample integration capabilities.
  • Easy to use: quickly and easily refer patients with intuitive, online forms.
  • File upload feature: use the upload feature to add key documents to your referral, such as patient scans or medical records.

3. Endodontist Referral Form

endodontist referral form

Who needs this? 

This endodontist form is a key form for dentists at clinics and oral care centers. It helps them send a patient to another dental surgeon for more specialized dental procedures, such as problematic root canals or traumatic dental injury treatment.

What’s it for? 

This endodontist referral form comprises a thorough breakdown of the doctor’s diagnosis and suggested treatment. It also includes contact information for both the referring doctor and the patient for keeping proper records. 

Key benefits:

  • Avoid human error: online, paper-free forms are an efficient solution for sharing critical information without any mishandling. 
  • Automated notifications: it’s easy to set up and share this form between all the involved parties with simple email notifications.
  • Add HIPAA compliance: use 123FormBuilder’s HIPAA-compliant form tool with the Enterprise plan to ensure you’re meeting medical regulations.

4. Ophthalmology Referral Form

ophthalmology referral form

Who needs this? 

This ophthalmology referral form is ideal for healthcare practitioners dealing with eye-related diseases and disorders. Ophthalmologists can use this form to transfer patients for specialist treatment following a diagnosis.

What’s it for? 

This detailed form collects information about the patient’s vision and eye health status. It includes key details on the patient’s condition , medication, allergies, and any relevant clinical findings. 

Key benefits:

  • Conditional logic flow: create forms that adapt to previous answers to ensure you’re not wasting time on unnecessary questions.
  • Multiple integrations: integrate referral form templates for healthcare on 123FormBuilder with your preferred tools for seamless workflows.
  • Automated notifications: send automated notifications to those involved upon form completion, such as the referred doctor.

5. Oral Surgery Referral Form

oral surgery referral form

Who needs this? 

This oral surgery referral form is essential for oral care professionals who need to transfer patients to another dentist for a surgical procedure. It contains the referring doctor’s recommendation for the treatment required and details on the exact teeth to be extracted.

What’s it for? 

This form can streamline backend operations for oral care doctors and surgeons, and facilitate a smooth experience for patients. It easily collects necessary details about the required surgery and reduces to-and-fro between multiple professionals.  

Key benefits:

  • Upload feature: add an upload field for images to your form to ensure you can include key details, such as x-rays or other documents.
  • No human error: cut down any scope of human error or misplaced data with online forms.
  • Multiple integrations: integrate the form into your existing work setup for streamlined operations.

6. Periodontal Referral Form

periodontal referral form

Who needs this? 

This periodontal referral form works well for dental practitioners who wish to recommend patients for gum or jaw-related surgery. 

What’s it for? 

This medical referral form is specifically for oral surgical procedures. It collects a patient’s personal information alongside a complete analysis of the referring doctor’s diagnosis.

The referring doctor defines the reasons for their referral and pinpoints all the problems a patient faces.

Key benefits:

  • Easily customizable: quickly and simply create medical form templates with 123FormBuilder’s drag-and-drop editor.
  • Go paper-free: digitize data collection to ensure hassle-free documentation with a lesser environmental impact.
  • Automate operations: automate form management actions to organize all your records efficiently.

7. Physician Referral Form

physician referral form

Who needs this? 

This physician referral form is meant for physicians and surgeons to recommend patients to other healthcare professionals. 

What’s it for? 

This extensive form focuses on the physician’s review of a patient’s condition. It also lists down the patient’s current medication and allergies. 

It enables physicians to get a second opinion or offer additional help to any patient following their diagnosis. 

Key benefits:

  • Easy setup: convenient setup and use with no-code customization capabilities at 123FormBuilder’s form builder.
  • Automated notifications: automatically notify the referred doctor or another team once the form is complete.
  • Conditional logic flow: only ask relevant questions with dynamic forms that adapt to previous answers. 

8. Psychology Referral Form 

psychology referral form

Who needs this? 

This psychology referral form is used by healthcare professionals to recommend a patient to a practicing psychologist. Any doctor can use this form to transfer a patient for mental health screening and support.

What’s it for? 

This patient referral form primarily contains the patient’s personal information and the referring doctor’s details. You can easily customize this template to add or remove any fields. 

This form helps doctors refer patients to specialized psychologists better equipped to support them.

Key benefits:

  • Conditional logic: use conditional logic to adapt the questions according to responses. For example, if the doctor indicates that the patient is seeking treatment for depression, the rest of the form should adapt to ask relevant questions.
  • Highly customizable: modify the template to collect details relevant to your practice and the patient at hand.
  • File upload feature: add key documents using the upload file function.

9. Referral Request Form

referral request form

Who needs this? 

This referral request form is ideal for healthcare professionals to send a patient to another specialized doctor. The referral can be either for a consultation or a surgical procedure. 

What’s it for? 

This form contains vital information about the diagnosis, the type of service requested, and the next steps for treatment. It contains personal details about the patient and the referring doctor. 

The general referral request can be used for a number of different referrals—it’s a key form for practicing healthcare professionals.

Key benefits:

  • Automated notifications: share real-time updates with everyone involved through automated notifications.

  • Reduce paper use: paperless documentation that minimizes the environmental impact of your practice.

  • Quickly and easily customize: ensure healthcare professionals can quickly create and distribute referral forms that fit the needs of the patient.

10. Maternal Self Referral Form

maternity self referral form

Who needs this? 

This self-referral form is made for maternity centers to offer to-be mothers the option to find a midwife through self-referral. Maternity care centers can review the form responses to find the best midwife for each woman. 

What’s it for? 

This form helps connect the most suitable midwives to pregnant women according to their medical history and conditions. It collects relevant information about a patient’s medical record and pregnancy in order to suggest the ideal midwife for them. 

This includes information on their native language, whether they’ve delivered children before, and if they’ve experienced any unexpected symptoms throughout the pregnancy.

Key benefits:

  • Fully secure: online forms are fully secure and less likely to be misplaced, ensuring no last-minute panicking for expecting parents. 

  • Powerful integrations: maximize productivity by integrating form responses into your existing workflow.
  • Conditional logic flow: ensure you’re getting the information you need with forms that adapt to the patient’s previous answers. For example, if a patient has experienced issues during the pregnancy, it’s essential to know the details.

Wrapping Up on Medical Referral Forms

Running your medical practice comes with a lot of work—collecting and sending patient referrals doesn’t have to be complex. These ten fully-customizable medical referral form templates will do the heavy lifting for you. 

123FormBuilder’s medical referral forms are quick and easy to create and manage, and help your practice digitize the referral process. Plus, they’re 100% secure to ensure confidential information remains private, and can be enhanced with the Enterprise plan to ensure they’re also HIPAA-compliant. 

Sign up free today and experience the easy-to-use tool and data management capabilities on offer.

Medical Referral Forms: Frequently Asked Questions

What do referrals mean in health and social care?

In the field of health and social care, a referral involves transferring a patient from the care of one doctor or healthcare provider to another. This can happen either at the patient’s request or at the doctor’s recommendation—when the required service is beyond their professional expertise. 

A referral includes all relevant details about a patient and their medical condition. This ensures a seamless patient transfer and enables the referred doctor to carry out the treatment effectively.

What is a referral system in a hospital?

A referral system is a framework allowing doctors and healthcare practitioners to prescribe services that are unavailable at their hospital or clinic. 

This system is in place to transfer any patient to a different hospital or facility for treatment by a specialist.

What is a patient referral form?

Healthcare professionals use a patient referral form to recommend their patients to another specialist or facility. This comprehensive form contains details about the patient, medical history, current condition, medication, allergies, and recommended treatment. 

What is a medical referral letter?

A healthcare provider writes a referral letter when transferring a patient to another practitioner for a diagnosis or post-diagnosis treatment. It’s a detailed letter containing further details on the patient’s health records, medication, present concerns, and similar information. 

The medical referral letter summarizes the patient’s condition, and why they’re being recommended for transfer.

What is a third-party referral?

A non-healthcare professional uses a third-party referral to request medical aid for a patient. Put simply, a patient’s acquaintance, friend, or family member can send a third-party referral to request care on their behalf.

Originally published on May 6, 2022

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