Free Clinician-to-Clinician Referral Letter Template

What is a referral letter?

A referral letter is a professional communication from one clinician to another recommending specialized evaluation, treatment, or consultation for a shared patient or client. Referrals occur across many scenarios: a therapist refers a client to psychiatry for medication evaluation; a primary care doctor refers a patient to cardiology for a heart condition; a pediatrician refers a child to speech therapy; a psychiatrist refers a patient to an addiction specialist. A well-written referral letter summarizes the patient's current clinical status, relevant history, what treatment or assessment the referring clinician recommends, and why this referral is needed. The letter serves as an introduction to the specialist, provides essential clinical context, and establishes continuity of care. Specialists rely on referral letters to understand the referring provider's perspective, avoid duplicating assessment work already done, and tailor their evaluation to the specific referral question. Referral letters also create documentation of care coordination and ensure the referring provider remains informed of specialist findings when relevant to ongoing primary care.

What's in this template

This referral letter template includes:

• Referring Provider Information: Name, title, credentials, practice/clinic name, contact information, date of letter
• Receiving Provider/Specialist Information: Name, title, credentials, specialty, practice/clinic name, address
• Patient/Client Identifying Information: Name, date of birth, address, phone number, emergency contact if appropriate
• Brief History of Presenting Problem: How long the patient has experienced symptoms, key triggers or context, impact on functioning
• Relevant Past Medical/Psychiatric History: Previous diagnoses, prior treatment attempts, surgeries or medical conditions relevant to the referral, medication trials
• Current Psychiatric/Medical Status: Current symptoms, severity, functional impact, any safety concerns or risk factors, current medications
• Current Treatment & Providers: What treatment the patient is currently receiving, with whom, since when, response to current treatment
• Reason for Referral: Specific clinical question the referring provider is asking the specialist to address (e.g., "evaluation for medication management," "diagnostic assessment for possible ADHD," "specialized trauma treatment")
• Relevant Diagnostic Information: Current diagnoses or diagnostic questions, severity ratings or scores from assessments if available, clinical formulation if it would help the specialist
• What Has Been Tried: Previous treatment modalities, medications trialed, response to each, what did not work
• Patient Goals & Preferences: What the patient hopes to gain from specialist evaluation or treatment, any preferences regarding treatment approach
• Urgency & Scheduling: Whether the referral is routine, soon, or urgent; preferred appointment timing; any scheduling constraints
• Previous Records: What records the specialist should request (prior evaluations, hospital records, psychiatric reports, psychological testing)
• Communication & Follow-up: How and when the specialist should communicate back with the referring provider, whether the patient is being seen concurrently by both providers, expectation for ongoing care coordination
• Referring Provider Signature & Date: Signature attestation

When to use this template

Use the referral letter template when:

• Referring a patient to a specialist for evaluation, medication management, or specialized treatment
• Recommending a higher level of care (e.g., inpatient hospitalization, intensive outpatient program)
• Transferring a patient's care to another provider or changing settings
• Requesting consultation on a complex or comorbid condition
• Coordinating care across multiple providers and disciplines
• Creating documentation of clinical decision-making and care continuity
• Ensuring specialists have necessary clinical context before seeing the patient

This template is used across all medical and mental health disciplines: psychiatry, therapy, primary care, pediatrics, neurology, addiction medicine, and all medical specialties.

How to use the template with Scriber

Record your discussion with the patient about the referral with consent and Scriber transcribes the conversation. Rather than composing a formal referral letter from memory after the appointment, you have a transcript capturing what you discussed, what the patient said about their symptoms and history, and what they want from the specialist. Use the transcript to draft the referral letter: extract relevant clinical details and the patient's own narrative, synthesize your clinical assessment and reasoning, frame the specific referral question clearly for the specialist, and ensure the letter meets professional standards. This keeps your focus on the patient conversation while AI handles transcription.

Download (free)

This template is available as a printable PDF and editable DOCX file. Customize it to match your specialty and referral patterns, adjust for your typical referral relationships, and use it as a standard format for all referral letters.

[Download PDF]

Related templates

• Discharge Summary Template — Template for concluding a course of treatment
• SOAP Note Template — Standard progress note format for clinical documentation