Contact SalesLog in
Contact SalesLog in

Referral Form Template

Submit and track referrals with our expertly crafted Referral Form Template.

SurveyMonkey is rated 4.5 out of 5 from 18,000+ reviews on G2.com

Our Referral Form Template is carefully designed to simplify the process of referring patients, clients or students to specialists, services or programmes. Healthcare providers, counsellors, educators, organisers and social workers can use this comprehensive form template to gather, share and store all the information that is needed to submit and process a referral. 

Referral form templates collect necessary information to facilitate the referral of patients, clients or students to appropriate specialists or services.

Customise the template to include fields for the names and contact details of both the referring and receiving parties, a description of the reason for referral and any pertinent medical or personal information. 

Distribute the form via email, your website or directly during consultations. Once the form is completed and submitted, the data is collected and organised, ensuring that the referral process is seamless and that the receiving party has all the necessary information.

Use this template to: 

  • Simplify the referral process
  • Accurately collect all of the important details 

Referral forms gather essential information necessary for effective referrals. Typical form fields include the following:

  • Name and contact details 
  • The reason for the referral
  • The specific services or specialists being referred to

You can customise the form to include any specific questions that match your organisation’s specific needs.

Ensure smooth and effective referrals with insights from our template. Get started now to enhance your referral process and provide seamless support for your patients, clients or students.

We have so many powerful features to help you launch surveys quickly, but here are our most popular ones for new users.

Out-of-the-box themes, accessible colour palettes, custom fonts, branding and more.

Collect survey responses via email, website, SMS, social media, QR codes, offline and more.

Automatic results summaries, filters, custom dashboards, crosstab reports, text analysis and more.

Flower shop owner looking at his phone, next to a review showing 5 out of 5 stars

Read about our customers, explore webinars and get guides on collecting feedback in your industry.

Woman reading research blog posts on a tablet, next to four blue and green bar charts

Get tips on how to create better surveys, hear the latest product news or check out our research.

Man wearing headphones and using a laptop, next to an image of SurveyMonkey's logo

Access tutorials on how features work, learn more about billing and contact Customer Support.