Referral Feedback Survey

The Referral Feedback Survey captures the patient's perspective on how well the referral process worked when they were sent to a specialist or another provider. Care transitions are a common source of patient frustration and medical errors, and this survey helps identify breakdowns in the referral workflow. Patients report on whether they understood why they were being referred, how long they waited for the specialist appointment, whether their records and test results were available at the specialist office, and how well the two providers communicated about their care.

The survey evaluates the entire referral chain from the initial recommendation through the specialist visit and back to the referring provider. Key questions address whether the patient received clear instructions about the referral, whether staff helped with scheduling or insurance pre-authorization, and whether the specialist had adequate background information to avoid redundant testing. Patients also rate how well results and recommendations from the specialist were communicated back to their primary care team.

This template is essential for primary care practices that make frequent referrals, multi-specialty groups looking to improve internal coordination, accountable care organizations (ACOs) focused on care continuity, and any practice participating in value-based care models where care coordination quality directly impacts reimbursement. The feedback helps referral coordinators identify process gaps and strengthen relationships with specialist partners.

Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Referral Feedback Survey from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.