Physician Referral Form


(4.8 / 5) 86 votes
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Get your Physician Referral Form in 3 easy steps

  • 01 Fill and edit template
  • 02 Sign it online
  • 03 Export or print immediately

What is Physician Referral Form Template?

The physicians referral form is the document you need whenever you want to refer patients to a specific specialist for further treatment. Not every clinic can provide all the treatments in a wide range of areas. Sometimes doctors decide to refer patients to their colleagues from other medical establishments.

In this case, you have to complete the referral form for your patient and send it to the clinic you choose. Doctors can accept referral forms from other clinics as well, considering whether they can help these patients or not.

There is no unified template that all clinics can use. Usually, each clinic creates its own form with the clinic’s logo on the title. However, there are universal forms you can just simply adjust in a few steps up to your needs. It will significantly ease your work. You can choose the template on PDFLiner, put the logo of your clinic, and add the sections if you need or keep it that way.

What I need the Physician Referral Form for?

  • The physician referral form PDF is required by the medical establishment that works with different patients. Its doctors can use the form whenever they decide that there must be a consultation received from the outside, from another specialist. In this case, the form must be sent to another doctor;
  • Doctors that receive the template need it to check out the patient’s health and official request from the clinic and their colleagues. The form usually contains a detailed description of the patient and the case;
  • Patients can ask doctors for a referral whenever they need a second opinion from another specialist.  They can contact their doctor and send the request to the hospital.

Physician Referral Form on PDFLiner

How to Fill Out Physician Referral Form?

You can easily find a free physician referral form on PDFLiner. This online editor allows you to fill out any form online. There are all the tools you need, so you can start filling the sections whenever you need to provide the document to a colleague or your patient. It is recommended for clinic use. You can create or adjust the template up to your needs and save it on your device.

You can add the document to your library on PDFLiner and fill it in with the name and diagnosis of each patient online. It does not take much time. Once you do it you have to send the form to the other party. It is also recommended to download the completed form on your device and keep the copy for your medical establishment. Here is what you need to include in your physician referral form sample:

  1. Provide information on the physician you are referring to. Include the date, MD, name, phone, and fax number;
  2. Provide information about the patient, including the name, date of birth, insurance company, policyholder name, address, and policy type;
  3. Describe the symptoms and diagnosis of the patient. Pick the part of the body that is affected and the tools you used to test the condition;
  4. Include the information about your medical establishment and your specialization;
  5. Provide information on the insurance if there is any.

Fill Physician Referral Form on PDFLiner

Organizations that work with Medical Referral Form

  • Any medical center on US territory.

What people say

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    University student
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Fillable online Physician Referral Form
(4.8 / 5) 86 votes
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