Physiotherapy Referral Letter: Structure and Rules

A physiotherapy referral letter does three jobs in one page: it tells the doctor what you found, what you are doing about it, and what you want from them. Most clinicians write too much history and not enough of the third part, which is the only part the reader has to act on. The structure below is the one that gets read in a busy clinic, and it works as a physiotherapy referral letter template you can keep as a snippet in your records system.

The second half of this page is the part that marketing articles on referrals leave out entirely. In the USA, what you may give a referrer is governed by federal law, and in Canada and Australia it is governed by your own regulator's standards. Lunches, gifts and thank-you gestures of the kind those articles recommend are exactly what those rules address. This guide is education for clinicians and practice owners in the USA, the UK, Canada, Australia and New Zealand. It is not legal advice, and every source is dated in the references.

What goes in a physiotherapist referral letter to a GP

Keep it to one page and put the ask near the top. A doctor reading twenty letters between patients will read your first three lines and your last one, so the request belongs in both places.

Patient identifiers and the date. Name, date of birth, your reference, the date you saw them, and the date of the letter if it is not the same.
One line on why you are writing. For example: asking for an opinion, reporting a finding, requesting imaging consideration, or informing them of a change. Say which it is immediately.
What the patient came with. Presenting problem, how long, mechanism if there is one, and the course since onset. Two or three sentences.
What you found. The objective findings that matter to this request, not the whole assessment. Include the specific test results and the measurements you are relying on, and name the outcome measure and its score if you used one; our outcome measures guide covers which travel well in a letter.
What you have done and how the patient responded. Treatment so far, the home program, and the response, with numbers where you have them.
Your reasoning in one or two lines. Not a diagnosis you are not entitled to make, and not a hedge either. State what concerns you and why.
The request, written as a question the reader can answer. "Would you consider blood tests for inflammatory causes given the night pain and morning stiffness beyond an hour?" is answerable. "Please advise" is not.
What you will do meanwhile, and what would make you write again or send the patient sooner.
Your name, title, registration number where it is customary in your market, and a route to reply that a practice can actually use.

A few habits matter more than the wording. Write the letter the same day, because a letter about last week's finding reads as less urgent than it is. Say explicitly if you have already told the patient to see the doctor urgently, and say what you told them, so that nobody assumes somebody else is handling it. And where a finding is a potential emergency, telephone and then write; a letter is not a safety net. Our red flags guide sets out which findings belong in that category.

For US readers the same structure works for a physical therapy referral letter, with two differences in register: cite the plan of care rather than the episode, and be specific about what you need for authorization if that is the real purpose of the letter. Our plan of care guide covers what has to be in the document the letter refers to, and SOAP notes covers the record it comes from.

One more point of professional courtesy that is also a standard. The HCPC requires registrants to share relevant information with colleagues involved in a person's care where it is appropriate to do so, and the equivalent duty exists in every market here. A letter is how that duty is met in practice, and the patient should know what is being sent and why.

Do you need a doctor's referral at all?

This is the question patients type, and the answer differs by market, so answer it once for your own market and then link to that answer. In much of the USA a patient may come to a physical therapist directly, with the detail set by state law, which is covered in the direct access guide. In the UK, NHS physiotherapy can often be reached without seeing a doctor first, and private care never needs a referral, although an insurer may ask for one; see NHS physio self-referral. In Australia, a referral is not needed for private physiotherapy, and a doctor's management plan is what opens a subsidized route, explained in the chronic condition management plan guide. In Canada and New Zealand, self-referral is normal in private practice, with funder rules deciding the paperwork.

For a practice owner, the operational point behind the question is this: a referral letter is not the only route in, and the practices that grow build both. Direct access brings patients who found you themselves. Referrals bring patients who were sent. The two need different front doors and different follow-up, and you need the second even in a market where it is not required, because the doctor who has met you sends the complicated ones.

Building referral relationships

The advice in circulation on this is tactical and unevidenced: rehearse a pitch, befriend the front desk, drop in with coffee, tell physicians which patients you do not want. None of the pages that recommend it offers any evidence that it produces referrals, and some of it is the behavior the rules in the next section exist to control. What follows is the version that survives both.

Be useful in writing. A clear, timely letter is the only referral marketing that reaches the doctor at the moment they are deciding where to send someone. Report back on the patients they send, including the ones who did badly, and close the loop at discharge. A referrer who hears nothing assumes nothing happened.

Then make yourself easy to send to:

One named contact and one route that works, answered by a person during stated hours.
A realistic waiting time, stated honestly and updated when it slips.
Clarity about what you treat and what you do not, so that the doctor is never embarrassed by a referral you cannot take.
A discharge summary that the referrer can read in thirty seconds.
A rule that urgent findings are telephoned, not emailed and hoped for.

Where meeting people is part of it, go with something to say. Offering to speak at a practice meeting on a topic they chose is a professional contribution. Case discussions, joint reviews of complex patients and shared pathways all count too. The broader marketing of a practice is covered in the marketing guide and the local search side in the local SEO guide, and asking for reviews has its own rules in the Google reviews guide.

Measure it the dull way: referrals by source each month, whether those patients completed the plan of care, and whether the referrer sent a second one. A referrer who sends one patient a year is a contact; three or four a month is a relationship, and relationships are built on completed episodes rather than on coffee.

What may you give a referrer?

Less than the marketing articles assume, and in the USA the question is criminal as well as professional. This section states the rules we could read in the primary documents, market by market. Where we could not read the current figure or the local standard, the page says so rather than guessing.

The USA first, because it is the strictest and the least discussed. The federal anti-kickback statute makes it an offence for a person knowingly and willfully to solicit or receive, or to offer or pay, remuneration in return for referring an individual for a service payable under a federal health care program, with a stated penalty of a fine of up to one hundred thousand dollars or imprisonment of up to ten years, or both. Read the statute's own words before you rely on anybody's summary of them, and take advice from a healthcare attorney before you set up any arrangement that moves value between a referral source and your practice, including rent, medical directorships, marketing services and staff shared between two businesses.

The physician self-referral rules, commonly called Stark, sit alongside it and work the other way round: they permit specific things within limits. One of those is the nonmonetary compensation exception, which covers items or services, not cash or cash equivalents, up to an annual aggregate limit per physician per calendar year.

The regulation sets that limit at three hundred dollars and says it is adjusted each calendar year to the nearest whole dollar by the change in the Consumer Price Index for All Urban Consumers, so the figure that applies now is higher than the one in the regulation's text. We are not stating the current figure on this page. The only authoritative source for it is the Centers for Medicare and Medicaid Services' own annual update page, and that page could not be read on the date this guide was written. Look it up on the CMS physician self-referral CPI-U updates page before you act.

Two further conditions sit in the regulation itself: the compensation must not be determined in a way that takes account of the volume or value of referrals, and it must not be solicited by the physician or the physician's practice. There is also a narrow cure if an entity goes over the limit inadvertently, available once every three years for the same physician.

Canada, where the standard is the clearest written statement in any of these markets. The College of Physiotherapists of Ontario's Conflict of Interest Standard, effective February 1, 2025, lists among prohibited activities paying for or providing other benefits to other parties in return for referrals, and providing referrals to other parties in return for payment or other benefits. It also rules out contract terms that incentivize selling physiotherapy products or non-physiotherapy services, and it excludes from its concern only gifts of a token or cultural nature of insignificant monetary value. Where a conflict cannot be avoided, it has to be disclosed to the patient, with practical alternatives offered and the management of it documented. Other provinces have their own college standards; read yours rather than Ontario's.

Australia. The shared Code of conduct for registered health practitioners is direct about this in section 8.10. Practitioners are told not to offer inducements to colleagues, and not to enter arrangements that could be seen as providing them. The same section tells them to act in the best interests of patients when making referrals, and not to ask for or accept inducements, gifts or hospitality from companies that sell health products. Section 8.11 covers financial dealings with patients, including not accepting gifts beyond tokens of minimal value. The code was issued in June 2022; check the current version on the Ahpra site, since it is reviewed from time to time.

The UK and New Zealand. The HCPC's standards of conduct, performance and ethics require registrants to declare anything that might create a conflict of interest and to make sure it does not influence their judgment, which is the standard that an arrangement with a referrer has to satisfy. The HCPC does not publish a gifts and hospitality standard in the way the Australian and Ontarian regulators do, so a UK practice should also take its own legal advice on anything resembling a payment for referrals. For New Zealand we could not read the Physiotherapy Board's standards on the day this page was written, so no position is stated here: read the Board's own standards and code of ethics before setting up any arrangement with a referrer.

The safe operating rule in all five markets is short. Pay nobody for a referral and accept nothing for making one. Keep hospitality to the kind you would be comfortable describing in writing to your regulator. Do not tie anything of value, including rent, equipment, staff time or marketing spend, to the number of patients someone sends you. And if an arrangement has to be explained carefully to sound acceptable, it is not.

What actually produces referrals?

Honestly: completed episodes of care and letters that arrive. Those two are what a referrer experiences, and everything else on the usual list is a proxy for them. There is no published evidence in the pages that rank for this subject that any specific outreach tactic converts, and anyone selling you a referral growth program should be asked for their data.

So the practical answer is to improve the thing that is actually measured by the person deciding. Keep waiting times honest, keep discharge summaries short and prompt, telephone about anything urgent, tell the referrer what happened, and stay inside the rules above so that the relationship never has to be defended. Patients who finish their care tell their doctor, which is slower than a lunch and considerably more durable. The patient retention guide covers the clinic-side half of that.

The short version

Write one page, put the request in the first three lines and the last, give the findings that support it, and say what you will do meanwhile. Telephone before you write when the finding is urgent. Answer the "do I need a referral" question once for your market, in one place, and point everything else at it.

Build the relationship on being easy to send to and on reporting back, and measure referrals by source and by completed care rather than by meetings had.

Then stay inside the rules, which almost nobody writing about this subject mentions. In the USA the anti-kickback statute and the Stark limits govern what may pass between you and a referrer, and the current nonmonetary compensation figure comes from CMS and nowhere else.

Ontario's College names paying for referrals, and being paid for them, among its prohibited activities. Australia's shared Code of conduct rules out offering inducements to colleagues. A UK registrant declares the interest. For New Zealand this page states no position, so read the Board's own standards before you assume one.

References

United States Code, 2023 Edition, Title 42, section 1320a-7b, Criminal penalties for acts involving Federal health care programs, subsection (b) Illegal remunerations. Read on govinfo October 26, 2026. https://www.govinfo.gov/content/pkg/USCODE-2023-title42/html/USCODE-2023-title42-chap7-subchapXI-partA-sec1320a-7b.htm
Electronic Code of Federal Regulations. 42 CFR 411.357(k), Nonmonetary compensation, including the annual CPI-U adjustment and the cure provision, and 411.357(m), Medical staff incidental benefits. Accessed October 26, 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-411/subpart-J/section-411.357
College of Physiotherapists of Ontario. Conflict of Interest Standard, effective February 1, 2025. Accessed October 26, 2026. https://collegept.org/standard/conflict-of-interest-standard/
Australian Health Practitioner Regulation Agency and National Boards. Shared Code of conduct, sections 8.10 Conflicts of interest and 8.11 Financial and commercial dealings. Date of issue June 2022. Accessed October 26, 2026. https://www.ahpra.gov.au/Resources/Code-of-conduct/Shared-Code-of-conduct.aspx
Health and Care Professions Council. Standards of conduct, performance and ethics, standards 2.7 on sharing information with colleagues and 9.4 on declaring conflicts of interest. Accessed October 26, 2026. https://www.hcpc-uk.org/standards/standards-of-conduct-performance-and-ethics/

Written and checked by the PocketPhysio editorial team. Last updated 2026-10-26.