Referral Survey

William R. Pupkis, CMPE, Healthcare Consultant

ReferralSurveyManaging referral sources is vital to a practice’s growth. By tracking information regarding referred patients you can learn which practices/physicians are sending patients and what kinds of cases are being referred. As you begin to develop an effective referral program, it will also be helpful to understand why your referral sources select your practice.

I have found that the following factors influence referrals: friendliness with colleagues, timely submission of follow-up reports regarding the referral, and ease of fitting those patients into your schedule. Requesting feedback, such as via the sample survey below, is a productive way to start a dialog with your referral sources regarding their needs and expectations. Future referrals will come from physicians if they and their patients are satisfied with the level of care received at your practice.


Disagree (1)
Agree (5)
I often have the need to refer patients to:
An orthopaedic surgeon 1 2 3 4 5
A physical medicine & rehab. specialist 1 2 3 4 5
I usually refer my patients to ABC Orthopaedic Clinic 1 2 3 4 5
I base my choice of referral on:
• Patient care/needs 1 2 3 4 5
• Convenience to patient 1 2 3 4 5
• Proximity to my practice 1 2 3 4 5
• Past patient satisfaction 1 2 3 4 5
• Colleague recommendations 1 2 3 4 5
• Insurance participation agreements 1 2 3 4 5
• Other________________________ 1 2 3 4 5
Working as a team is important to me 1 2 3 4 5
I have a personal relationship with the physicians to whom I refer 1 2 3 4 5
I view the physicians to whom I refer as an extension of my own practice 1 2 3 4 5
I appreciate personal recognition from the physicians to whom I refer 1 2 3 4 5
What do you like most about ABC Orthopaedic Clinic?
What do you like least about ABC Orthopaedic Clinic?
What can we do to better serve your needs?
To which of our physicians do you refer patients?

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This entry was posted on Wednesday, May 28th, 2014 at 12:50 pm and is filed under Practice Management. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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