How to Create a Referral Form

Referral forms can be used in a plethora of applications. Doctors, lawyers, counselors, friends and loved ones all can use a referral form. You can use a referral form to attract new business, recommend another doctor or connect two people together as friends. Regardless, you can follow a similar procedure to create any referral form.

Make a header. Write “Referral Form” at the top your page. You can add words to the header to make the form more specific, such as “Client Referral Form.”

Create fields for the person’s name. Include a field for vital contact information such as mailing address, phone number and email.


Create fields for the referral. The person who fills the form out needs to include the information about the person they wish to refer. These fields should include the same sort of contact information. Further, you should leave some blank lines for a “reason for referral.” This will help the final receiving party to understand the purpose of the referral and some facts about it.


Finalize the form. Add in any other information that pertains to your particular situation. You can create any further fields you need to obtain as much information as possible.