Patient Referral Form Template

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.

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.

With this patient referral form template, you can upload and share medical files 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.

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.