---
title: Rare Disease Specialist Referral Form Template | Paperform
description: Professional referral form template for rare disease specialists. Capture diagnosis, symptom timeline, treatments, genetic testing, and clinical trial interest to streamline patient referrals.
url: "https://paperform.co/templates/rare-disease-specialist-referral-form"
type: static
generatedAt: "2026-03-28T00:44:58.999Z"
---

[← Back to free form templates](/templates/)    ![Rare Disease Specialist Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/rare-disease-specialist-referral-form.png)
    [Preview](https://_preview.paperform.co/ai-template/rare-disease-specialist-referral-form) [Use this template for free](/create?ai-template=rare-disease-specialist-referral-form)    [Contact Forms](/templates/category/contact/)[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 dealing with rare diseases, getting patients connected with the right specialist quickly and efficiently can make all the difference. This **Rare Disease Specialist Referral Form** is designed to streamline the referral process by gathering all critical medical information in one organized, professional format.

This form template captures everything a rare disease specialist needs to evaluate a new patient referral: current diagnosis details, comprehensive symptom timelines, previous treatment history, genetic testing results, and the patient's interest in clinical trials. By collecting this information upfront, you reduce back-and-forth communication, speed up appointment scheduling, and ensure specialists can provide informed, targeted care from the very first consultation.

**Perfect for healthcare providers, rare disease clinics, genetic counselors, and specialty medical centers**, this form works seamlessly whether you're a referring physician, care coordinator, or patient advocate. The conditional logic ensures that only relevant follow-up questions appear based on responses, making the form feel intuitive and reducing completion time.

Paperform's healthcare-focused features make this template particularly powerful. The clean, professional design builds trust with patients and referring providers, while the flexible editor lets you customize questions to match your specific rare disease focus area. You can embed this form directly on your clinic website or send it as a secure link to referring physicians.

Once submitted, use **Stepper** to automate your intake workflow—route urgent cases to priority review, send confirmation emails to patients and referring doctors, update your patient management system, and create task lists for your care coordination team. You can also use Papersign to gather any required consent forms or information releases as part of the referral process, keeping everything organized and compliant.

With Paperform's robust security measures including SOC 2 Type II compliance, you can trust that sensitive patient information is handled with the highest standards of data protection. This form helps rare disease specialists, genetic clinics, and specialty healthcare providers deliver faster, more coordinated care to patients who need it most.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
 ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg)
 ![G2 - 4.8 out of 5](/images/g2-st.jpg)
  [Try Paperform free now](/register)
## More templates like this
  [![Palliative Care Specialist Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/palliative-care-specialist-referral-form.png)

### Palliative Care Specialist Referral Form

A comprehensive referral form for connecting patients with palliative care specialists, covering diagnosis, symptom management needs, hospice considerations, and care environment preferences.](/templates/palliative-care-specialist-referral-form/)
[![Physical Therapy Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/physical-therapy-referral-form.png)

### Physical Therapy Referral Form

A comprehensive referral form for physicians to submit patient physical therapy referrals, including diagnosis codes, treatment authorization details, and scheduling preferences.](/templates/physical-therapy-referral-form/)
[![Clinical Laboratory Test Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/clinical-laboratory-test-request-form.png)

### Clinical Laboratory Test Request Form

A comprehensive laboratory test request form for healthcare providers to order diagnostic tests, submit patient information, manage insurance billing, and specify specimen collection and results delivery preferences.](/templates/clinical-laboratory-test-request-form/)
[![Clinical Trial Recruitment Inquiry Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/clinical-trial-recruitment-inquiry-form.png)

### Clinical Trial Recruitment Inquiry Form

Connect potential clinical trial participants with research opportunities by collecting diagnosis, treatment history, trial preferences, and location information.](/templates/clinical-trial-recruitment-inquiry-form/)
[![Healthcare Provider New Patient Message Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/healthcare-provider-new-patient-message-form.png)

### Healthcare Provider New Patient Message Form

A comprehensive new patient intake form for healthcare providers that streamlines initial contact, insurance verification, medical history collection, and appointment scheduling in one seamless experience.](/templates/healthcare-provider-new-patient-message-form/)
[![Nuclear Medicine Specialist Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/nuclear-medicine-specialist-referral-form.png)

### Nuclear Medicine Specialist Referral Form

A comprehensive referral form for nuclear medicine specialists to request diagnostic imaging scans with detailed clinical information, patient history, and insurance pre-authorization details.](/templates/nuclear-medicine-specialist-referral-form/)
[![Raynaud's Phenomenon Screening Questionnaire](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/raynauds-phenomenon-screening-questionnaire.png)

### Raynaud's Phenomenon Screening Questionnaire

A comprehensive screening tool for Raynaud's phenomenon that documents color changes, identifies triggers, assesses underlying conditions, and determines the need for rheumatology consultation.](/templates/raynauds-phenomenon-screening-questionnaire/)
[![ACC Severe Injury Rehabilitation Plan](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/acc-severe-injury-rehabilitation-plan.png)

### ACC Severe Injury Rehabilitation Plan

A comprehensive rehabilitation planning form for ACC severe injury cases, coordinating multi-disciplinary care teams, tracking long-term recovery goals, and monitoring milestone achievements throughout the rehabilitation journey.](/templates/acc-severe-injury-rehabilitation-plan/)
[![Addiction Treatment Center Patient Safety Incident Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/addiction-treatment-center-patient-safety-incident-report.png)

### Addiction Treatment Center Patient Safety Incident Report

A comprehensive safety incident reporting form for addiction treatment facilities to document medication errors, elopement risks, patient safety concerns, and ensure proper state licensing notifications and regulatory compliance.](/templates/addiction-treatment-center-patient-safety-incident-report/)
[![Allergy & Immunology Records Transfer Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/allergy-immunology-records-transfer-form.png)

### Allergy & Immunology Records Transfer Form

Request and transfer comprehensive allergy and immunology medical records, including skin test results, immunotherapy protocols, anaphylaxis history, and emergency action plans between healthcare providers.](/templates/allergy-immunology-records-transfer-form/)
[![Ambulatory Surgery Center Pre-Operative Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/ambulatory-surgery-center-pre-operative-intake-form.png)

### Ambulatory Surgery Center Pre-Operative Intake Form

Complete pre-operative assessment for ambulatory surgery patients including anesthesia history, NPO compliance verification, medication management, and same-day discharge planning.](/templates/ambulatory-surgery-center-pre-operative-intake-form/)
[![Anonymous Psychiatric Medication Mail Order Safety Concern Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/anonymous-psychiatric-medication-mail-order-safety-concern-report.png)

### Anonymous Psychiatric Medication Mail Order Safety Concern Report

Confidentially report safety concerns about psychiatric medication mail order services to state pharmacy boards. Submit anonymous tips about patient monitoring issues, medication errors, or compliance violations.](/templates/anonymous-psychiatric-medication-mail-order-safety-concern-report/)