Referral Script Form Info

SHOP REFERRAL SCRIPT FORM

General Header Info | Color Info

Instant download PDF;

The LactForms Referral Script form is a highly effective tool for marketing your services to local doctors and healthcare providers. Instantly downloadable as a PDF file and formatted like a prescription pad in portrait orientation with your practice information as a header, it includes space for the parent and child’s names with checkboxes for common presenting issues.

LactForms Referral Script forms made into pads

They're ideal for professional printing as tear-off notepads or sticky notes to distribute to local pediatric, OB/GYN, and other healthcare offices (printing permission document included). Available in blue and grey, with more colors soon.

Experienced private-practice LCs have been using this marketing idea for decades now as the main source of their doctor referrals and a quick way to increase business. Much better than handing out stacks of your business cards, which often end up jumbled up with other specialists' cards in a forgotten area of provider offices.

Providers find printed notepads and sticky pads convenient way to refer their patients to you for lactation services. They just check off a few boxes, tear off the page, and hand it right to their patient, who then has your contact information and a handy reminder to make an appointment with you right away.

    Custom printing services for both notepads are available at many places online.  Here's a few links (most can also make custom sticky notes):

    Print Specifications

    • Professionally printed size:  4.25" x 5.5" (10.795cm x 13.97cm)—If you prefer a different size (or need to fit European size pages), most printing companies can adjust the image. But if they require a different image size, it can be provided it at no extra charge, just ask!
    • Notepads:  Glued edge on short side (4.25"/10.795cm) with cardboard backing (portrait orientation)
    • Sticky notes:  Sticky area on short side (4.25"/10.795cm)
    • Pad size:  25-50 pages (25 is probably best for most provider offices)
    • Ink:  2-3 color or greyscale printing (color catches the eye better but greyscale may be less expensive)
    • Background color:  White

     

    Downloadable PDFs Included

    1. 8.5" x 11" (21.6cm x 28cm) page with ONE image on the page—No printer marks
    2. 8.5" x 11" (21.6cm x 28cm) page with FOUR images on the page—No printer marks
    3. 9" x 11.5" (21.6cm x 28cm) page with ONE image on the page—With printer marks
    4. 9" x 11.5" (21.6cm x 28cm) page with FOUR images on the page—With printer marks

      Also includes:
    5. Quick Start Guide
    6. Header Instructions
    7. Printing Permission (copyright release)

    Header Options

    Our Referral Script form looks more professional with the HeaderBox option showing your branding colors and logo. But the other header options work just fine because on this form only they've shorted to the name, credential, phone number, email, and website for easier reading since the pad size is smaller (a quarter of the size of a standard page). Learn more about our general header options

    Feedback Welcome

    Please share your feedback about how well this works for your practice. I'd also love to know the printing cost so I can let others know what to expect. And of course always feel free to reach out with any questions or other marketing ideas!