Free template
Referral letter template
A referral the receiving consultant can triage from the first paragraph, with the history they would otherwise phone for.
Download the PDFFree, no sign-up. Fill it in on screen or print it.
What it asks for
What is on the formThe secretary completes
- Practice letterhead, date and reference
- Patient: name, date of birth, MRN and address
- Specialist or clinic, hospital, referral date and priority
- Reason for referral
- Relevant medical history
- Current medications and allergies
- Examination and investigations
- Sign-off: name, qualifications and Irish Medical Council number
Using it well
- State the question you want answered in the first line of the reason for referral.
- Mark the priority honestly; the receiving clinic plans its list from it.
- Attach or list the results you mention, with their dates.
Open it in the sample practice
The sample practice is the real Ask Brigid on invented patients, open without a sign-up. This document joins its Library with the next sample-practice update; the Library already holds the practice’s templates.
Sources
- The shipped template's field list (Brigid stationery v12), read 24 October 2026
Checked against the sources above on 23 September 2026. Issuers change their forms; check the official page before you rely on a detail here.
In Ask Brigid this paperwork sits beside the diary and the record: Practice management for private consultants.