Free Printable Doctor Referral Form Template – Medical Referral Form PDF

Download this free printable doctor referral form template and start issuing professional medical referrals today. Available as a print-ready PDF in A4, A5, and US Letter sizes — fill it in by hand or digitally, then print and hand it to your patient.

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WHAT’S INCLUDED
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✔ 1 Doctor Referral Form Template (1 page, 3 sizes)
✔ A4 size — standard international medical form size
✔ A5 size — compact referral slip format
✔ US Letter size — standard for US clinics and hospitals
✔ Print-ready PDF — no editing software required
✔ Free instant download

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WHAT THE FORM INCLUDES
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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

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WHAT DOES A DOCTOR REFERRAL FORM LOOK LIKE?
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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.

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WHO IS THIS FOR?
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✔ 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

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

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PRINT SIZES INCLUDED
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✔ A4 — 210 × 297 mm (standard in UK, Europe, and international clinics)
✔ A5 — 148 × 210 mm (compact referral slip, fits standard medical folders)
✔ US Letter — 8.5 × 11 inches (standard for US medical offices and hospitals)