Referral letters arrive by fax, email and sticky note, and half of them miss the reason. I would rather give referrers one link that asks for what you need. You get the same facts, in the same order, every time.
Who it is for
Specialists, imaging centres, therapy practices and any clinic that takes referrals from outside doctors.
What each question is for
- Referrer name, role, practice, email: so you can write back with questions.
- Patient name, birth date, phone: to match the right person.
- Service and urgency: where the referral goes and how fast.
- Reason, history and medicines: the context a triage nurse reads first.
- Agreement box: the referrer says the patient knows and agrees.
What the referrer's AI would ask
"Which service is this referral for?" Then "How soon should the patient be seen?" Then "What is the reason for the referral?" It shows the answers and sends only after a yes. See agent-fillable forms.
Before you use it
Check your local privacy rules before collecting health data. This is a form, not medical advice. No scans or documents can be attached, so write where records can be found. A general referral form covers other kinds of referral, and a patient satisfaction survey closes the loop later. More in forms for clinics.
Questions
Is this safe for urgent cases?
No. The form says it is not for emergencies, and you should repeat that on your page. Urgent cases belong on the phone or in your normal clinical channel.
How do I triage the queue?
Download the CSV and sort by urgency_level, then by submission time. Filter refer_to to give each service its own list.
Can a referrer use an AI to fill it in?
Yes. A referrer can paste the agent prompt into their chat and give the AI the facts. It shows every answer and submits only after the referrer confirms.