Doctor Referral Forms

If you are sick or need some medical advice you have to visit a doctor for the treatment. The organizations usually offer health insurance to their employees and these insurance agencies are connected to a group of health care providers. You are then referred to the type of consultant you require for your treatment. It could be possible that you have visited a general physician and he refer you to a specialist for specific care. Whatever be the route if you are referred to a physician you have to fill a doctor referral form to complete the documentation formalities.

A doctor referral form is a form that your physician needs to fill and sign before referring you to a specialist for better treatment and diagnosis. The referral form holds complete patient information, results of the tests performed on the patient, the reason for referring ,etc.

This is a simple form which begins with your profile as you have to mention your name age gender, date of birth and contact in the given spaces, the next section of the form ask you about your insurance provider and you have to write the insurance company name in the column. The next section ask you about the physician you are previously consulting, the medicine and investigation you have taken before for the treatment of the disease if you have been referred by another doctor then it has to mention in the form. All these requirements are necessary to keep as a record of your health or disease profile and you can claim insurance on such referrals easily. Every health centre has designed their referral forms according to their specifications but the general format is the same. The form is signatures by the patient and the doctors as an evidently documented proof.

Getting a correct diagnosis can be very lengthy process yet a very important one for your health and life. If you do not know which doctor to consult ask your general physician to refer to one. He might need different tests done before he can evaluate which doctor to refer you to. Different diseases and conditions can have overlapping and similar symptoms. Even the medical tests you get done can not be differentiated by your general physician or medical specialist. That is where a specialist doctor comes in.

A doctor referral form holds the following information :

  • The name and age of the patient
  • Contact information of the patient
  • Symptoms and signs in detail
  • Names of the test performed and their results
  • Treatment Given to the patient
  • Brief medical history of the patient
  • Reason for referral
  • Name and specialty of the doctor referred to
  • Signature of the referring doctor

Your general physician or medical specialist might refer you to a doctor in the same clinic or hospital, or he might refer you to a specialist outside of the medical facility. In the case of a referral to an outside or visiting doctor, additional information about his clinic or hospital is also mentioned in the doctor referral form as well.


Doctor Referral Form


Microsoft Word (.doc size: 52 KB)

Simi Karton

Dr. Simi Karton currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health-related information with a straightforward approach.

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