was successfully added to your cart.



version 5.2+

Power Practice version 5.2 will see the introduction of the new patient referral form. Working similar to the prescription pad, the referral form will have all the elements you need to match your in house paper referral form.


  1. Select the patient menu drop-down, select the Patient Files module
  2. Once there, select the Referrals tab
  3. After adding your Refer To information, select the referral line
  4. Select the Form button

The Referral Form header will indicate the patient’s name, and chart number.

Refer To: The drop-down will contain the clinic the patient is being referred to

Print Practice Name: Unchecking this box will enable you to select doctor information instead

Print Practice Logo: If you have added an image of your practice logo, you can add it to the referral document.

Print Gender: This will add the patient’s gender on the form.

Print Account Holder: This will add the Account Holder information on the form.

Print Insurance Info: Enabling this will add the policy information on the form

Date Out & Date Due: You can modify the dates for your referral here, otherwise it will automatically have the ones that you set up previously

Print Tooth Chart: You can choose the appropriate dentition for the patient

Heading: Add a title for the Tooth Chart if included

Comment: Add your notes regarding the referral or any additional information you wish to include. Create and add templates using the ellipses (…) button.

Add Comment as a Referral Note: This will save the comments into the patient’s history with the note type of REF

Copy Over Referral Note: This will fill in any note in the patient’s Referred To note section

Optional Information: The three lines available are spaces given for any additional information you wish to add to the referral form. Use the Col and Row to change the position of the lines

Materials Forwarded: Indicates what materials are enclosed with the referral form with one customizable option

Send Via: An indicator of how the referral form was sent over

Copies: Number of copies required to be printed


OK: Selecting Ok will bring up a list of printers including print to PDF

Cancel: Exit the utility without printing or saving

Set As Default: Save your settings to save time on future referrals

A Referral Note will automatically be added in the patient’s Referral tab with each print out IF Add comment as a Referral Note is ticked.

Referral form preview that was saved as a PDF

Here is an example of the referral form with all features enabled.

Print Friendly, PDF & Email