--- generated_by: surveylegend-page-markdown title: Referral Form Template | SurveyLegend description: Collect the details needed for a business or program referral. Adapt these referral form fields and create your form with SurveyLegend. Start free. canonical: https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/referral-form-template/ --- # Referral Form Template [Create your survey ](https://app.surveylegend.com/register/)[Try the survey](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/referral-form-template/#try-template) Preview on a device Show the desktop survey preview Show the tablet survey preview Show the mobile survey preview ![Referral Form: first question and response field, desktop preview](https://www.surveylegend.com/survey-template-media/previews/referral-form-demo-preview.avif) ![Referral Form: first question and response field, tablet preview](https://www.surveylegend.com/survey-template-media/previews/referral-form-demo-preview-tablet.avif) ![Referral Form: first question and response field, mobile preview](https://www.surveylegend.com/survey-template-media/previews/referral-form-demo-preview-phone.avif) Referral Form [Preview](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/referral-form-template/#try-template) Share [Facebook ](https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Freferral-form-template%2F)[LinkedIn ](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Freferral-form-template%2F)[X ](https://x.com/intent/tweet?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Freferral-form-template%2F\&text=Referral%20Form%20Template)[Reddit](https://www.reddit.com/submit?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Freferral-form-template%2F\&title=Referral%20Form%20Template) This referral form template helps your team collect the information needed to introduce someone to a service or program. Its eight fields cover the referrer, the requested service, the reason for the introduction, and the next contact step. Adapt the example to your referral process and build your form with SurveyLegend. ## Use a Referral Form for a Clear Next Step 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. **Make the next introduction easier to share.** Collect the details you need for a referral and a useful follow-up. Create your own referral form with SurveyLegend and start for free. ## 8 Fields to Include in Your Referral Form 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. Try the survey ## A little feedback. A clearer picture. Explore this 8-question example at your own pace. Every question is optional. Preview on a device Show the survey at full desktop width Resize the survey to a tablet-width preview Resize the survey to a mobile preview with scrolling inside the frame Choose a look Use Classic: a white survey card over the background photo Use Light: dark text over a light tint covering the background photo Use Dark: light text over a dark tint covering the background photo SurveyLegend demo Question 1 of 8 ### Referral Form 01 What is your name? Share your answer, or skip this question. 02 What email address should we use to contact you about this referral? Enter an email address, or skip this question. 03 Who are you referring? Please give the person's or organization's name. Share your answer, or skip this question. 04 Which service or program is this referral for? Share your answer, or skip this question. 05 Briefly describe the reason for the referral. Include only information needed for the introduction. Share your answer, or skip this question. 06 Has the person you are referring, or the contact at the organization, agreed to be contacted directly about this introduction? Choose one answer, or skip this question. Yes No, please coordinate through me Not yet I do not know 07 If direct contact has been agreed, what email address should the receiving team use? Otherwise, leave this blank. Enter an email address, or skip this question. 08 Is there anything else the receiving team needs to arrange the next step? Please avoid sensitive personal information. Share your answer, or skip this question. #### One last look Review your answers before submitting this demo. 0 answered #### Thank you for trying the survey! You’ve tried the template from the respondent’s side. Make it your own with SurveyLegend. [Create your own survey](https://www.surveylegend.com/register/) Checking submission availability… This is a demo. We count starts and submissions only. Your answers stay in your browser and are never sent or saved. **—**Starts **—**Submissions Activity is temporarily unavailable. ## Adapt the Form to Your Referral Process 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](https://www.surveylegend.com/features/) fields for the service, contact route, and email address. Before sharing the form, test both paths: direct contact agreed, and coordination through the referrer. ## Printable referral form template Use this printable referral form template to collect answers from people who prefer paper or are less comfortable with online forms. Give people a printed form for making an introduction when completing an online referral is less convenient. Download the PDF, print the 8-question questionnaire, and provide copies for people to complete by hand. It includes the same core questions as the online template, with space for written answers. Online or on paper, SurveyLegend helps you give your audience a way to respond that works for them. [![](https://www.surveylegend.com/user-guide-media/icons/download-pdf.svg) Download PDF](https://www.surveylegend.com/downloads/survey-templates/referral-form-template.pdf) Export referral form template as PDF ## AI prompt for a referral form 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. Referral Form creation prompt [Use prompt directly in SurveyLegend](https://www.surveylegend.com/register/) Create a free account, then paste the copied prompt into SurveyLegend. Already have an account? [Sign in to create your referral form.](https://app.surveylegend.com/login/) ## Review Referrals and Assign Follow-Up 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. ## Frequently asked questions ### Is a referral form the same as a recommendation survey? A referral form introduces a person or organization to a service. A recommendation survey asks how someone feels about recommending a business. Choose the referral form when your next task is arranging an introduction or reviewing a service request. ### Should I collect the referred person's contact details? Collect them only when direct contact is the agreed next step and your process allows it. Otherwise, ask the referrer to coordinate the introduction. Tell respondents how the details they provide will be used. ### Can SurveyLegend collect these referral fields? You can build the example with text, email, and choice fields. Review our [survey and form ](https://www.surveylegend.com/features/)features when choosing the fields and settings for your process. Any follow-up tracking described here is an operational step for your team. Web Forms and Questionnaires Template 1. [![Preview of the Meeting Form Template](https://www.surveylegend.com/survey-template-media/previews/template-meeting-form-template-survey-preview.avif) Web Form: Meeting Form Template Web forms & questionnaires Let’s face it: meetings have a reputation. Some people love them, others just survive them. But with the right tools, every meeting—yes, even the ones that could have been an email—can be clear, organized, and even enjoyable. That’s where the meeting form template from SurveyLegend comes in.](https://www.surveylegend.com/survey-examples-templates/meeting-form-template/) 2. [![Preview of the Suggestion Form Template](https://www.surveylegend.com/survey-template-media/previews/template-suggestion-form-template-survey-preview.avif) Web Form: Suggestion Form Template Web forms & questionnaires Ever wonder what your employees or customers are really thinking? Spoiler alert: they have thoughts. And they’re usually more than happy to share them—you just need to give them the right space to do it. That’s where our suggestion form template comes in.](https://www.surveylegend.com/survey-examples-templates/suggestion-form-template/) 3. [![Preview of the Website Visitor Profile Form Template](https://www.surveylegend.com/survey-template-media/previews/template-website-visitor-profile-form-template-survey-preview.avif) Web Form: Website Visitor Profile Form Template Web forms & questionnaires Your website looks great. Your content is on point. Your services are solid. But let’s ask the real question—who’s actually stopping by? That’s where the magic of a website visitor profile form comes in.](https://www.surveylegend.com/survey-examples-templates/website-visitor-profile-form-template/) Free survey maker ## Start creating surveys today *for free* Create and bring your ideas to life with the survey tool used by people all over the world. [Get started for free ](https://app.surveylegend.com/register/)[Book a demo](https://www.surveylegend.com/schedule-a-demo-of-surveylegend/) Academic research survey ### Ready to collect better research data? Create academic surveys and questionnaires from ready-made templates. [Sign up!](https://app.surveylegend.com/register/) Share this page [Facebook ](https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Freferral-form-template%2F)[LinkedIn ](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Freferral-form-template%2F)[X ](https://x.com/intent/tweet?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Freferral-form-template%2F\&text=Referral%20Form%20Template)[Reddit](https://www.reddit.com/submit?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Freferral-form-template%2F\&title=Referral%20Form%20Template) Ready when you are ## Create Your Referral Form Build a referral form that gives your team a clear place to start. Add your service names, explain the contact process, and test the form with a sample introduction before sharing it. [*Self-serve* Start free Create your first survey in minutes **Start free** ](https://app.surveylegend.com/register/)[*Guided help* Book a demo Talk with a SurveyLegend expert and choose the right plan. **Book a demo**](https://www.surveylegend.com/schedule-a-demo-of-surveylegend/)