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Doctor Referral Form Template

This doctor referral form comes with a few basic questions in's customizable template. You can start using your form right away by removing some questions and adding new ones. Using the doctor's advice form for medical conditions requires no coding knowledge!

Doctor Referral Form Template


What is a medical referral form?

The patient is directed to a different specialist to provide a more accurate health service with the advice of the doctor. The Online Doctor Recommendation Form is used in such cases to refer patients with the correct information flow. You can customize the form right away by selecting this online referral sheet from's library of referral form templates.

If you need a different referral form, you can review's Dental Referral Form Template.

What are the online doctor referral form template customization options?

You can start customizing your form by adding a question field for the patient's contact information. If you wish, you can continue with the long text question field to share the medical history. You can add the e-signature option to your form and sign to indicate that you approve the referral. At the last stage, you can share your form by embedding it on your clinic's website or via social media and e-mail.

Create online forms with ease, customize your form’s fields, design, and privacy options within a couple of minutes. By adding some of many types of form fields for all needs with’s drag and drop form creator screen, you can also create online surveys and exams. 

Powerful features: 

  • Conditional logic 
  • Create forms with ease
  • Calculator for exams and quote forms
  • Geolocation restriction
  • Real-time data
  • Detailed design customization

You can integrate the forms and surveys you created on with many third-party applications via's direct integrations and Zapier. These applications and integrations include creating or modifying a sheet on Google Sheets every time your form is submitted and creating a deal on Pipedrive for an order you received or a generated lead. 

There are no limits and boundaries when it comes to creating online forms, surveys, and exams with! You can choose one of many types of templates, create a form, and get started right away! Once you start with a template, you can easily customize your form fields, form design, and many other attributes!

You can share your forms in any way you like. If you want to share your form and collect responses through your form’s unique link, you can simply adjust privacy settings and copy-paste your form link anywhere. And if you would like to embed your form in your website, you can easily copy and paste embed code in your website HTML.

On, you can customize your form’s theme and design elements in depth. Once you switch to the ‘Design’ tab after getting your form done, you will see many different design customization options. You can change your form theme by choosing your own colors or picking one of many ready-made themes.