---
title: Primary Care to Electrophysiology Referral Form Template | Paperform
description: Streamline cardiac referrals with this comprehensive electrophysiology referral form for arrhythmias, palpitations, syncope episodes, and pacemaker evaluations. Built for primary care physicians and healthcare networks.
url: "https://paperform.co/templates/primary-care-to-electrophysiology-referral-form"
type: static
generatedAt: "2026-03-28T00:44:53.109Z"
---

[← Back to free form templates](/templates/)    ![Primary Care to Electrophysiology Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/primary-care-to-electrophysiology-referral-form.png)
    [Preview](https://_preview.paperform.co/ai-template/primary-care-to-electrophysiology-referral-form) [Use this template for free](/create?ai-template=primary-care-to-electrophysiology-referral-form)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
When managing patients with cardiac rhythm concerns, a streamlined referral process between primary care and electrophysiology specialists is essential for timely diagnosis and treatment. This **Primary Care to Electrophysiology Referral Form** is designed to capture all the critical clinical information needed for effective specialist evaluation—from documented arrhythmias and palpitation patterns to syncope history and pacemaker assessment needs.

Built with Paperform, this template helps primary care practices, cardiology clinics, and healthcare networks maintain a standardized, HIPAA-aware referral workflow. The form guides referring physicians through comprehensive documentation of symptoms, relevant cardiac history, diagnostic test results, and urgency indicators, ensuring that electrophysiologists receive complete context before the first appointment.

Conditional logic adapts the form based on presenting symptoms—whether the patient is experiencing palpitations, syncope, or requires pacemaker evaluation—surfacing only the most relevant questions. This intelligent branching saves time for busy physicians while ensuring no critical details are missed.

With Paperform's calculation fields and automated workflows, you can track referral priority levels, route urgent cases immediately, and integrate submissions directly into your EHR, practice management system, or scheduling platform. Use **Stepper** (stepper.io) to automate post-submission workflows: notify the specialist team, trigger appointment scheduling, send patient preparation instructions, or update referral tracking databases—all without manual data entry.

For multi-provider healthcare organizations, Paperform's role-based permissions and Agency+ features make it simple to deploy consistent referral forms across multiple locations while maintaining centralized oversight. Whether you're a solo primary care practice or a large healthcare network, this template helps you deliver coordinated cardiac care with greater efficiency and clinical precision.
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