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Doctor Referral Letter
If you need a doctor to give you a referral please have them fill out the attached Doctor Referral Letter. This will provide you with all the information that you need to contact the new doctor and make an appointment at your earliest convenience.

Free Sample Template
Format: Word PDF
# of Pages: 1
Printable: Yes


Doctor Referral Letter TemplateForm 3277
Format: Word PDF
Category: Medical, Doctor Office
Type: Referral

Doctor Referral Letter

[Your Name]

[Address]

[City, State, Zip]

[Date of letter]

[Recipientís Name]

[Title]

[Company Name]

[Address]

[City, State, Zip]

RE: Patient Name

Dear [Recipientís name],

I am writing this letter to obtain a referral to a specialist doctor.

I am seeking a referral for to following condition: _____________________________________________________.

I would like to request that I specifically be referred to:

Doctorís Name: ________________________________________________________________________________

Address: ______________________________________________________________________________________

City: __________________________________________ State: ___________________ Zip: ___________________

Please let me know at your earliest convenience when you have made the referral and you may contact me if you have any questions or are in need of additional information.

Best regards,

[Your Signature]