Sample Referral Letter from Doctor

If you are a doctor and want to refer your patient to some other doctor who has specialties in that particular case, you need to write a referral letter. If you have personal relations with that particular doctor, you can write the details in any manner but if you just know him, you need to write referral letter keeping in view all the formal requirements.
Some sample referral letters from doctors are also given below that will help you in writing a formal letter from a doctor. Some important tips to write a referral letter from doctor are given below;

  • You need to mention following important points regarding patient.
    – Specialty being referred into
    – Relevant medical details
    – Reason for referral
    – Referral date
    – First name and surname of patient
    – NHS number

UCLH hospital number (or whether the patient has attended UCLH before)

  • – Date of birth
  • – Gender
    – Full address, including postcode of the patient
    – Telephone numbers for the patient including preferred number to use
    – Notification of whether the patient needs an interpreter / advocate / other special assistance
    – Name and address of referring GP/GDP and practice name including phone and fax numbers
    – Name and address of registered GP practice including phone and fax numbers
  • Requirements of all Seven C’s of business communication should be considered when writing a referral letter to doctor specially Completeness, courteousness and correctness.
  • At the end mention your name and the places you do your practice.
  • Give a positive ending.
  • Proofread your letter at least once. Make sure all the necessary information are provided.

Here is sample Referral Letter from Doctor:

Sample Referral Letter from Doctor

Your Name:
Phone Number:
Postal Code:
Email Address:


Name of Recipient:

Name of Organization:

Phone Number:

Dear Sir/ Madam,

Thank you for referring [PATIENT NAME] to [Center Name]. Our team conducted a thorough clinical evaluation. Upon our discussions and based on the patient’s goal of [complete goal] we decided to perform a Medtronic ITB Therapies (Intrathecal Baleen Therapy) screening test.

The screening test involved [XX] mcg bolus of baleen injection via lumbar puncture. [Include information on physical therapist evaluation, such as times of evaluation [e.g., two, four, and eight hours following bolus injection] and results of evaluation]. Based on the success of the screening test, we plan to proceed with implantation of the Medtronic SynchroMed® Drug Infusion System for delivery of ITB Therapy on [DATE].

Thank you again for your referral. If you have any questions, please call me at [PHONE NUMBER].

Yours sincerely, / faithfully