Physician Referral Patterns Survey Form
Please complete this survey to help us understand current physician referral behavior patterns. Your responses will remain anonymous and are valuable for improving referral processes.
What is your primary medical specialty?
*
Please Select
Internal Medicine
Family Medicine
Pediatrics
Surgery
Obstetrics/Gynecology
Emergency Medicine
Other
How many years have you been practicing medicine?
*
Please Select
0-5 years
6-10 years
11-20 years
21+ years
How frequently do you refer patients to other physicians or specialists?
*
Daily
Weekly
Monthly
Rarely
Which specialties do you most commonly refer to? (Select all that apply)
*
Cardiology
Orthopedics
Gastroenterology
Neurology
Oncology
Other
What are the main reasons you refer patients? (Select all that apply)
*
Specialist expertise required
Diagnostic procedures
Treatment not available in practice
Patient request
Insurance requirement
Other
How do you typically communicate referral information to the receiving physician?
*
Electronic health record (EHR) system
Phone call
Fax
Email
Patient delivers information
Other
How satisfied are you with the current referral process?
*
1
2
3
4
5
Please rate your agreement with the following statements about the referral process:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Referrals are processed efficiently
1
2
3
4
5
I receive timely feedback from specialists
6
7
8
9
10
Patients understand the referral process
11
12
13
14
15
What are the most significant barriers you face when making referrals?
Do you have any suggestions to improve the referral process?
Submit Survey
Should be Empty: