How to fill out and submit a patient referral form
Using the online patient referral form allows a referring doctor to submit their referrals, and any attachments they may need to send, digitally through the secure mysecurepractice.com portal.
Locating the form
The referral forms are usually located under the ‘Referring doctor’ tab on the office’s website
On the ‘Referral Form’ page, you will see our referral form text along with a button to access the online form
Filling out the form
Once you enter the form, you can navigate by scrolling up and down the page to fill out the necessary information regarding the patient.
Note: the ‘complete and send’ button will show throughout the form for ease of use, but it should only be clicked once you have fully completed the form.
Adding attachments
Once you have completed the form and hit the ‘Complete and Send’ button, you will have the option to upload any necessary attachments.
Make sure once you upload and submit the attachment(s), that you see the window in the upper right hand corner stating ‘success’. If you do not see this window, your attachment may not have successfully been attached to the referral form.
Downloading the completed form
Once the form and any attachments have been submit to the referring office, you will have the option to download your submitted referral form. Simply click the ‘Download Submitted Form’ button and you will receive a pdf copy of the form you just submit. 
Accessibility Button
We have included a button on all of our truforms for accessibility purposes.
This button provides the following options:
- Changes the color of the form to black with white text
- Changes the color of the form to white with black text
- Increases text size on the page
- Decreases text size on the page
- Reverts all changes to the look of the form back to the original.
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