Referral Form Template

Use this example when a person or organization recommends someone for a business service or general program. Decide who receives the referral and what they will do with it before sharing the form. A submission should lead to a review or contact step your team can actually provide.

Keep clinical referrals and other specialist intake processes in a workflow designed for their requirements. This example covers a general introduction; it does not assess eligibility or make a referral decision.

Collect the referrer's name and email, the person or organization being introduced, the destination service, and a short reason for the referral. Then establish how the introduction should proceed.

Ask whether direct contact has been agreed before collecting the referred person's email. When the referrer should arrange the introduction, your team can follow up with the referrer instead. Avoid requesting detailed personal histories to explain a straightforward service need.

Replace the service field with your actual programs or service names if your team routes referrals by category. Explain what information belongs in the reason field and give a short example, such as “Needs help comparing the available training programs.”

In the introduction, identify the team that reads submissions and describe the expected next step. Add a response timeframe only if your team can meet it. Decide which fields must be completed to route the request; leave optional context optional.

For an organization referral, ask for a contact only when that person has agreed to the introduction. An organization name alone does not establish agreement to contact a particular employee. Use SurveyLegend’s choice and email fields for the service, contact route, and email address. Before sharing the form, test both paths: direct contact agreed, and coordination through the referrer.

Create a referral form in SurveyLegend with questions about the referrer, requested service, reason for the introduction, and agreed contact route.

This prompt includes eight fields and their response settings. Register for a free account to use it in SurveyLegend, then review and customize your form before sharing it.

Start by checking the requested service and the agreed contact route. Assign the referral to the relevant person, confirm missing details through the referrer, and record the next action in your team's tracking process.

Keep submission, contact, acceptance, and service delivery as separate stages. A submitted referral does not establish that the person was contacted or accepted. If many referrals reach the wrong team, improve the service choices or the form's introductory instructions.