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Patient Referral Form Template

Streamline patient referrals and increase efficiency at your hospital or office.

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Patient referrals can be a tedious and time-consuming process, especially if you're still using paper forms. Use this template to simplify patient referrals and track data in ways you'd never be able to with paper. Minimize time spent on referral forms to maximize time with patients. Ditch paper for good with Formstack's HIPAA compliant online form solution and powerful data capture tools.

Handle dozens of referral types.

Handle dozens of referral types.

Use Conditional Logic to create a form that can serve a variety of referral types. When referring a patient to a cancer specialist, the form will ask for the patient's family history of cancer. When referring to a cardiologist, a section will appear for information on their cardiomyopathies. If you refer to multiple doctors within specialties, you can include each doctor as an option and prefill the form with their information to avoid spending excess time on manual data entry.

Stay HIPAA compliant.

Stay HIPAA compliant.

Collect and share personal healthcare information across any device, while keeping patient data safe and secure with our HIPAA compliant solution. Formstack encrypts data and safely stores it in a database, keeping your organization compliant with HIPAA regulations. With this patient referral form template, you have full control over who views the information and can track user activity. We also provide HIPAA compliant integrations to simplify your healthcare data collection.

Safely and securely share medical files.

Safely and securely share medical files.

With this patient referral form template, you can upload and share medical files safely and securely. Using one form to transmit all your patient information will help you save time, minimize the possibility of errors, and house important data in one place. Uploading charts and medical history to a referral form is especially helpful if you refer patients to highly specialized doctors or handle very complex cases. From genetic tests and lab results to clinical notes and general medical records, all files uploaded on this template can be shared quickly and securely.

Increase efficiency.

Increase efficiency.

Digitize your patient referrals to increase efficiency in your hospital or office. Whether you process hundreds of referrals or thousands, upgrading to a digital patient referral form will increase productivity, improve communication, and simplify data management. Ditch the complicated process of paper forms for good! With this template, there's no need to write by hand, fax, or shred. An embedded signature field makes it easy to sign off on referrals with a simple swipe of your finger.

Social Proof

"Formstack increases the speed and efficiency and cuts down on the duplication of data entry for both patients and staff members."

Dr. Chris Bojrab,
President of Indiana Health Group

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