Patient Referral Form Template

With SurveySparrow, this patient referral form template is transformed into a tool to improve patients’ experience. Once you collect a patient referral, you can send personalized feedback surveys, track the responses, create cases, and give focused attention to every patient.

Styling & Branding

Using our builder, you can customize the look and feel of the medical referral form according to your needs. Our builder has pre-designed themes which you can apply with just one click. If you don’t find anything apt in the themes collection, you can create your own. Choose the background color, button color, and text colors of your choice. If you are good with codes, you can use a CSS editor to code your background.

Integrate with Google Sheets

Every detail collected from this pt referral form can be exported to a google sheet. You need to only toggle the integration ON in the tab and you’re done! The responses will be recorded instantaneously in the sheet and you can easily access it through the same tab. Using features of Google Sheets, you can segment the patient’s details and arrange better facilities for them.

Go Offline

In case of health drives being run in isolated places, the offline feature of SurveySparrow comes handy. This referral form template can be installed on a kiosk, or a tablet and medical professionals, or doctors can collect patient referrals with no internet connectivity.

Library of Question Types

Using our builder, you can customize this template into dental referral form, medical referral form or any other related to healthcare industry. Choose from different types of question types like multiple choice, rating based, contact form, etc. You can arrange the flow of questions by simply drag and drop.