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Referral Letter Template
A referral letter asks another clinician or service to see your patient and answer a specific question. Give the reason, the urgency, and the history they need, so your patient is seen at the right time.
- Free, no account needed
- Word and text downloads
- Two filled examples
Blank referral letter template
FreeREFERRAL LETTER [Clinic name] [Address] [Phone and fax] Date: [Date] To: [Name of specialist or service] [Clinic or hospital, address, fax or e-referral destination] Re: [Patient's full name] Date of birth: [Date] Health insurance number: [Number] Contact: [Patient's address and phone] Language and access: [Preferred language, interpreter, mobility or other needs] Dear [Dr. name or colleague], Thank you for seeing [patient name], age [age], whom I am referring for [reason for referral]. Urgency: [Routine, urgent, or emergent, and why] My question: [What you want answered: assessment, diagnosis, a procedure, management advice, or transfer of care] History of the problem: [Onset, course, key symptoms, and red flags present or absent] Examination: [Relevant findings] Investigations: [Results with dates; reports attached] Treatment so far: [What has been tried, with doses, duration, and response] Past medical history: [Relevant conditions and surgeries] Medications: [Name, dose, and frequency] Allergies: [Drug and other allergies, with reactions] Social context: [Living situation, work, caregiver, anything that affects attending] [Patient name] knows about this referral and agrees to it. [Their preferences or concerns, if any] Attached: [Reports, imaging, letters] Please contact me at [phone or email] if you need more information. Sincerely, [Your name, credentials] [Practitioner or billing number, if required] [Signature]
Use it for
- Specialist referrals
- Physical therapy
- Mental health services
- Diagnostic services
- Transfer of care
Two filled examples. Every part, filled in.
Each one follows the template. Use them to judge how much detail every part needs.
Referral letter to orthopedic surgery
Family physician to orthopedic surgeon, routine
Reason and question
Thank you for seeing this 68-year-old woman with right knee osteoarthritis that is no longer controlled with conservative treatment. I would be grateful for your assessment for a total knee replacement.
Urgency
Routine.
History
Two years of right knee pain, worse over the last 6 months. She can now walk only one block, uses a cane, and wakes at night with pain. No locking or giving way. No fever and no injury.
Examination
Antalgic gait. Right knee: small effusion, crepitus, flexion to 100°, lacks 5° of full extension, tender medial joint line. Ligaments stable. Left knee normal.
Investigations
Standing X-ray of the right knee, August 12, 2026: severe medial joint space narrowing with osteophytes. Report attached.
Treatment so far
12 weeks of physical therapy; weight loss of 6 kg (13 lb); acetaminophen 1 g three times daily; topical diclofenac; two corticosteroid injections, the last in June 2026, each helping for about 6 weeks.
Medical history and medications
Hypertension and type 2 diabetes, both well controlled (A1c 6.9% in July 2026). Amlodipine 5 mg daily, metformin 500 mg twice daily. Allergic to penicillin (hives).
The patient
Lives with her husband in a two-story house and no longer uses the stairs. She knows about the referral and would like to discuss surgery.
Referral letter to cardiology
Family physician to cardiologist, urgent
Reason and question
Thank you for seeing this 59-year-old man with 3 weeks of chest tightness on exertion, which I suspect is stable angina. I would value your assessment and advice on further testing.
Urgency
Urgent: new exertional symptoms with several risk factors. Please see him within 2 weeks if possible.
History
Central chest tightness when walking uphill or climbing two flights of stairs, easing within 5 minutes of rest. Mild shortness of breath with the episodes. No pain at rest, no episode longer than 10 minutes, no fainting.
Examination
BP 148/90, HR 78 and regular, BMI 31. Normal heart sounds, no murmurs. Chest clear. No leg swelling.
Investigations
ECG, October 8, 2026: sinus rhythm, no ST changes. Lipids, A1c, and creatinine pending; I will forward the results.
Treatment so far
Started aspirin 81 mg daily and nitroglycerin spray as needed. Advised to stop smoking; he has accepted support to quit. Told to call 911 if pain comes on at rest or lasts more than 10 minutes.
Medical history and medications
Hypertension; smoker, 30 pack-years; father had a heart attack at 54. Ramipril 5 mg daily. No known drug allergies.
The patient
Works as a delivery driver. He knows about the referral and agrees to it.
What goes in each part.
Reason and question
Why you are referring, and what you want from the person you are referring to.
- The reason for referral, in a sentence
- One specific question: an assessment, a diagnosis, a procedure, management advice, or taking over care
Avoid: “Please see and advise” with no question. It makes the letter harder to triage.
Urgency
Many services triage on this line, so make it clear.
- Routine, urgent, or emergent
- Why: the finding or risk that sets the priority
- Red flags present or absent
Avoid: Marking everything urgent. Save it for cases that need it, and say why.
Clinical history
What the specialist needs to answer your question, and no more.
- The history of the problem, and the examination findings
- Investigations with dates, with the reports attached
- Treatment tried, with doses, duration, and response
Avoid: Pasting the whole chart. Attach reports instead of copying them out.
Medications and allergies
The specialist may plan treatment before they see your chart.
- Current medications, with doses
- Allergies, with reactions
- Relevant medical and surgical history
Avoid: Leaving them out because they are in your chart. The specialist may not have access to it.
The patient
What helps the service book the visit, and the patient attend it.
- Contact details, preferred language, and interpreter needs
- Mobility, caregiver, or transport needs
- That the patient knows about the referral and agrees to it
Avoid: Forgetting to tell the patient what happens next, and roughly how long it may take.
Your details
So the receiving clinician can reach you with questions.
- Your name, credentials, and contact details
- Your practitioner or billing number, if the receiving service needs it
- Your signature, and the date
Common mistakes, and how to avoid them.
No clear question
Say what you want answered. A specific question gets a specific answer.
Urgency missing or unexplained
Without it, a referral that needs to be seen soon can wait in the routine queue.
Results described, not attached
Attach the reports, with dates, so tests aren’t repeated.
Missing medications or allergies
The specialist may plan treatment before they see your chart.
The wrong service or form
Some services only accept their own referral form or an electronic referral. Check before you send.
Use in Vero
Frequently asked questions.
What should a referral letter include?
The reason and the question you want answered, how urgent it is and why, the relevant history, examination, and results, the treatment tried, medications and allergies, the patient’s contact and language needs, and your contact details.
How do you write a referral letter to a specialist?
Start with the reason and your question, and state the urgency. Then give only the history, findings, and results that bear on the question, attach the reports, list medications and allergies, confirm the patient agrees, and add your contact details.
What is the difference between a referral letter and a consultation letter?
A referral letter asks another clinician to see your patient. The consultation letter is their reply, with their findings and recommendations.
How long should a referral letter be?
Usually one page. Attach results and reports rather than copying them into the letter.
When should a referral be marked urgent?
When a delay could change the outcome, such as suspected cancer, quickly worsening symptoms, or findings your local guidelines list as urgent. Say why in the letter, and call the service if the patient needs to be seen sooner than an urgent referral allows.
Is this referral letter template free?
Yes. Copy it, or download it as a Word or text file. No account needed.
Can Vero write a referral letter from my visit?
Yes. Vero drafts the letter from your visit note in your template. Review and edit it, then export it to PDF or Word, print it, or email it.
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Referral management
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Vero Documents
Fill referral forms and other PDFs from the visit and the chart.
Discharge summaries
A worked example, a reusable structure, and a quality checklist.
Your template. Filled in from the visit.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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