formisoft

Referral Feedback Survey

Asks about referring provider, specialist seen, and referral reason clarity. Built for primary care practices monitoring referral coordination quality.

Questions
10
Page
1
Time
about 3 min
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Your practice

Referral Feedback Survey

Live preview. Tap through it like a patient.

Who it is for

  • Primary care practices monitoring referral coordination quality
  • Multi-specialty groups improving internal referral workflows
  • Accountable care organizations tracking care transition metrics
  • Referral coordinators identifying process gaps and delays

What's inside

  1. Referring ProviderText
  2. Specialist SeenText
  3. Referral Reason ClarityMultiple Choice · 5 choices
  4. Scheduling AssistanceMultiple Choice · 6 choices
  5. Wait Time for SpecialistLong Text
  6. Records Available at SpecialistMultiple Choice · 4 choices
  7. Care Coordination RatingMultiple Choice · 6 choices
  8. Comments on Referral ExperienceLong Text
  9. Survey DateDate
  10. Would You Recommend Us?Multiple Choice · 3 choices

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Referral Feedback Survey, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

Related templates

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Questions

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Yes. You can add, remove, reorder, or reword any of the 10 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Yes. The Referral Feedback Survey works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the Referral Feedback Survey to your account and make it yours in a few minutes.

Cancel anytime · BAA included

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