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When an appointment ends with “see another practitioner”, use this sheet to record what you have been asked to arrange. Its purpose is to keep the referral question, booking details and return conversation together.
This is an organisational resource. It does not decide whether you need a referral, choose a specialist, interpret a referral letter or change your care plan. Copy the fields into your own document or print them. Yellow does not save or send the information you write.
Start with the referral you were given
Date of the conversation: ____________________
Practitioner who suggested the referral: ____________________
Person, department or service named: ____________________
Question they want the next practitioner to help answer: ____________________
Letter or written request received: Yes / Not yet / Not discussed
If the purpose is unclear, ask: “What question are we asking this person to help with?” Record the explanation you receive. If a name or abbreviation is difficult to read, ask the referring clinic to confirm it rather than guessing.
You can also ask: “How soon do you want me to arrange this, and whom should I contact if I cannot get an appointment in that time?” Copy the response. This worksheet supplies no timing rule of its own.
Confirm who makes the booking
Will the referring clinic arrange it, or should I contact the next clinic? ____________________
Booking contact confirmed by the clinic: ____________________
Branch, address or appointment link: ____________________
Do I need to send the referral letter before booking? ____________________
Appointment date and confirmation: ____________________
A named department and a confirmed appointment are different details. Leave the appointment field blank until you have a confirmation. If you have to contact another clinic yourself, the local clinic shortlist sheet gives you space to compare practical replies.
For a time-sensitive question, contact the clinical team rather than waiting to complete the form. A booking conversation cannot replace medical advice about urgency.
Agree on which records will travel with you
Ask the next clinic what it wants to receive. Keep the original documents available, and note what you have actually shared.
| Record requested by the clinic | Where my copy is | Recipient and channel confirmed | Shared on |
|---|---|---|---|
Do not write a diagnosis into a blank field because it appears in a search result. Use the wording on the referral or ask the practitioner to explain it. If you have conflicting instructions from two clinics, record the difference and ask them to clarify.
Before sending a report, confirm the recipient and channel with the clinic. Share only what you intend to share. This page has no upload box, messaging service or connection to either practitioner.
Plan the conversation after the visit
Will the next practitioner send a summary to the referring clinic? ____________________
Do I need to request or carry a copy? ____________________
Who will discuss the findings and next steps with me? ____________________
How should I arrange that conversation? ____________________
If I have not heard back by the agreed date, whom should I contact? ____________________
Ask these questions rather than assuming the clinics will exchange everything automatically. The sheet records their arrangements; it does not create them.
Keep one unresolved question visible
The question I still need answered: ____________________
Who I will ask: ____________________
What they replied: ____________________
Keep this sheet beside the appointment preparation resource. If the next visit includes a new test request, use the separate test-request sheet for the instructions and result conversation.
Your handover record is complete when you know the referral question, the booking arrangement, which records to take and whom to contact afterwards. It is not proof that care has happened. Update it from the conversations you actually have.
This resource provides general information and does not diagnose a condition or replace advice from a qualified practitioner.