Physician-to-physician referral

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Simply replace the unfilled areas such as "[]" and "[date]" with your information.

Dear [physician],

Thank you for referring [Patient] to me. I saw [him/her] on [date].

I [agree/disagree] with your diagnosis of [diagnosis] and prognosis of [prognosis]. I do recommend [recommended treatment option for patient].

I am including a copy of my consultation notes and have directed [Patient] to follow up with you in one to two weeks. [Patient] indicated that [he/she] already had an appointment with you.

Please let me know if I can be of further assistance with this or any other matter. As always, it is a pleasure working with you on these cases.



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