Doctors Referral Form Template: Free Printable PDF

Download this free printable doctor referral form template and issue professional medical referrals today. It is a one-page, print-ready PDF in A4, A5, and US Letter sizes. Fill it in by hand or digitally, then print it and hand it to your patient.

WHAT’S INCLUDED

• 1 Doctor Referral Form Template (1 page, 3 sizes: A4, A5, US Letter)
• Print-ready PDF, no editing software required
• Free instant download

WHAT THE FORM INCLUDES

This medical referral form template covers all the essential fields a standard doctor to doctor referral needs:

• Patient name, date of birth, and contact information
• Referring physician name and practice details
• Receiving specialist or provider information
• Type of referral (routine, urgent, or specialist)
• Reason for referral and primary diagnosis
• Relevant medical history and current medications
• Insurance and authorization details
• Referring doctor signature and date

WHAT DOES A DOCTOR REFERRAL FORM LOOK LIKE?

A standard doctor referral form (also called a physician referral form, referral slip, or referral document) is a one-page medical form used when a primary care physician or general practitioner refers a patient to a specialist, hospital, or another healthcare provider.

It typically includes:

• The patient’s personal and insurance information
• The referring doctor’s details and practice
• The specialist or provider being referred to
• The clinical reason for the referral
• Any relevant diagnosis codes or medical notes
• The doctor’s signature

This template follows that standard format: clean, structured, and immediately usable.

WHO IS THIS FOR?

• General practitioners and family doctors issuing specialist referrals
• Physicians writing doctor to doctor referral forms
• Clinics and medical offices needing a printable referral form template
• Hospitals managing patient transfers and specialist referral requests
• Specialists and consultants receiving structured referral documentation
• Healthcare administrators setting up a standardized referral process
• Medical students and educators looking for a referral form example or sample

HOW TO DOWNLOAD

1. Click “Add to Cart” and complete checkout (this product is free)
2. Go to My Account, then Downloads
3. Download your PDF file
4. Print on standard paper or fill it in digitally on your device

PRINT SIZES INCLUDED

• A4: 210 x 297 mm (standard in UK, Europe, and international clinics)
• A5: 148 x 210 mm (compact referral slip, fits standard medical folders)
• US Letter: 8.5 x 11 inches (standard for US medical offices and hospitals)