Pediatrician Referrals: Scripts and Templates

To build pediatrician referrals, give the office accurate information about who your therapy practice serves, identify its referral process, and make the handoff easy for staff and families. A useful referral resource explains services, accepted ages, practical access, payment arrangements, and the contact route for scheduling and coordination.

The relationship should support appropriate care and family choice. It should not depend on paying for referrals, pressuring office staff, or promising appointment access you cannot provide.

Key takeaways

Give a pediatric office what it needs to refer: services, ages, setting, availability, payment arrangements, the referral route and what happens after.
Use the office’s own process: find the referral coordinator, offer a one-page sheet, and stop when staff ask you to stop.
Replace every template field before sending, and never represent payer participation, availability or expertise more broadly than you can substantiate.
Keep general practice outreach separate from patient-specific coordination; under HIPAA, permitted treatment disclosures can differ from marketing disclosures.¹
Offer no gifts or payments tied to referrals: the federal Anti-Kickback Statute concerns remuneration to induce or reward referrals, and remuneration can extend beyond cash.²
Measure completed handoffs and the barriers that stop them, not referral volume alone.

What does a pediatric office need from a therapy practice?

An office may need to identify a suitable therapy provider quickly while balancing many other tasks. Your introduction should answer the practical questions rather than describe every philosophy, piece of equipment, or course you have completed.

Question	Information to supply
Which children can this practice evaluate?	Discipline, actual services, and age range
Where do visits happen?	Location, legitimate service area, or service setting
Can a family use these appointments?	Accurate availability and access information
What payment arrangements apply?	Actual network participation and self-pay process
How is a referral sent?	Approved referral contact route and required information
What happens after referral?	Intake contact, scheduling steps, and coordination process

The office may have its own preferred format. Ask first and adapt your material rather than expecting staff to use a packet designed around your convenience.

Step 1: Which pediatric offices should you approach for referrals?

Create a short list based on geography, population, and service fit. A practice offering infant PT should not use the same introductory message as an SLP practice focused on school-age communication services.

Record the office name, public professional contact route, referral coordinator if known, and any stated vendor or resource policies. Do not gather private staff contact information or treat access to a physician’s personal address as a marketing advantage.

Learn whether the office accepts provider introductions, maintains a resource list, or has a formal process for new community providers. If introductions are not accepted, respect that boundary.

Step 2: What goes on a one-page therapy service and referral sheet?

Keep the sheet easy to update. A brochure with broad claims is less useful than a concise document with accurate practical information.

Practice name: [Actual name]
Clinical contacts: [Names, actual credentials, and roles]
Discipline and services: [Specific services actually provided]
Accepted ages: [Actual range]
Setting and location: [Clinic, home visits, or other legitimate setting]
Access information: [Verified parking, entrance, or accommodation contact details]
Payment arrangements: [Accurate network participation and self-pay information]
Availability: [Dated statement or a contact route for current information]
Referral route: [Approved secure fax, portal, or other practice-approved route]
Information required: [Actual administrative and clinical requirements]
Family contact route: [Phone, contact page, or scheduling route]
After referral: [Who contacts the family and what the next steps are]
Resource review date: [Actual date the information was checked]

Do not include patient stories, photographs, or identifiable case examples in a general referral sheet. Explain your service using practice facts and general process information.

Step 3: What should a referral introduction email to a pediatric office say?

Subject: Pediatric [OT, speech-language, or PT] service information for your referral team

“Hello [Name],

I am [Name and actual credentials] with [Practice] in [Location]. We provide [specific services] for [ages] in [setting]. We are currently accepting inquiries for [accurate availability statement].

Who is the best person to receive a one-page service and referral-information sheet? It explains our payment arrangements, scheduling contact, and how families can begin the intake process.

We would also appreciate knowing which information your team needs for a clear referral handoff.

Thank you,
[Name]
[Actual credentials and role]
[Practice contact details]”

The email asks for a suitable next step. It does not ask a busy office to promise referrals or review a large attachment without context.

Step 4: What should you say when you call a pediatric office?

Use a brief script if the office accepts introductory calls:

“Hello, my name is [Name] from [Practice]. We provide pediatric [discipline and services] for [ages]. I am calling to ask how your office prefers to receive information about community therapy services. Is there a referral coordinator or resource contact I should speak with?”

If transferred, continue:

“Thank you. We have a one-page sheet with services, payment information, current availability, and referral instructions. Would that be useful, and what is the appropriate way to send it? Are there details your team usually needs that I should include?”

If the office declines, thank staff and stop. An appropriate introduction should not interrupt patient care or become repeated pressure.

What should a referral letter from a pediatric therapy practice say?

Subject: Community pediatric [discipline] services at [Practice]

“Dear [Physician or referral coordinator],

[Practice] provides [actual services] for children [ages] at [setting and location]. Our team includes [names and actual relevant credentials]. We would like to make our service information available to your team when a family may benefit from an appropriate therapy evaluation.

Our services include [concise list within actual competence]. Current scheduling information is [accurate statement or contact route]. Payment arrangements include [accurate information], with benefits and any applicable administrative requirements confirmed through our intake process.

Families can contact [route] to ask about service fit and available appointments. Your team can send referral information through [approved route]. Please include [actual required information] according to your office’s procedures and applicable requirements.

After a referral is received, [brief accurate intake workflow]. For permitted care coordination, our clinical contact is [name and approved route].

We welcome questions about our services and would appreciate learning how your team prefers community providers to communicate. Our goal is a clear handoff and useful information for families as they choose care.

Sincerely,
[Name]
[Actual credentials and role]
[Practice]
[Contact details]”

Replace every field before sending. Do not represent payer participation, availability, or clinical expertise more broadly than you can substantiate.

Step 5: When is a follow-up to a pediatric office appropriate?

Make a reasonable follow-up if the office has invited contact or the resource was sent through an accepted process. A suggested planning interval is one or two weeks, adjusted to office preference; it is not a proven universal response window.

“Hello [Name], I am following up on the [Practice] service information sent on [Date]. Did the referral sheet reach the appropriate person? If your team needs a different format or additional practical information, I can update it. Thank you.”

After that, avoid repeating a sales message. Future updates should be relevant, such as a changed service, verified network status, or meaningful availability change, and should follow the office’s communication preference.

Step 6: How should your practice handle a referral once it arrives?

Once a referral arrives, assign an owner to check administrative completeness, contact the family through the approved route, explain the next step, and resolve missing information.

Use status categories such as received, awaiting information, family contacted, scheduling in progress, scheduled, and unable to proceed. Define what each means so an unresolved referral does not appear complete merely because someone attempted a call.

Keep the referral record in the appropriate protected system. A marketing spreadsheet should not contain child identifiers, clinical history, or copies of referral documents.

If you choose a goal such as acknowledging referrals within one business day, confirm that staffing supports it and explain exceptions. Do not promise access to an evaluation in that time unless the practice can actually provide it.

Step 7: How do you share care-coordination updates with the pediatrician?

Distinguish general practice outreach from patient-specific treatment communication. Under HIPAA, permitted treatment disclosures can differ from marketing disclosures. Apply the actual purpose, safeguards, state requirements, and practice procedures rather than assuming every communication requires—or avoids—authorization.

Use HHS guidance on treatment, payment, and health care operations when reviewing your coordination process.¹ School records and other special circumstances may involve additional rules.

Confirm the recipient and appropriate channel before sending information. A useful clinical update is part of care coordination, not an opportunity to turn a child’s progress into promotional material.

Can a therapy practice give gifts or payments for referrals?

The federal Anti-Kickback Statute addresses knowing and willful remuneration to induce or reward referrals involving services payable by federal healthcare programs. Remuneration can extend beyond cash. OIG’s fraud and abuse law overview explains the framework.²

Do not assume a meal, gift, marketing arrangement, or cash-pay service is automatically outside all applicable restrictions. State rules and other requirements can also matter. Have an appropriate adviser review proposed financial arrangements; this outreach kit does not evaluate safe harbors or establish that a particular arrangement is lawful.

How should you measure referral development?

Measure useful relationships and completed handoffs: offices reached through an accepted process, resource requests, referrals received, administrative barriers, evaluations scheduled, and evaluations attended.

If several referrals cannot proceed because your sheet misstates availability, fix the sheet. If staff repeatedly need the same missing document, revise the instructions. Avoid judging the relationship solely by referral volume, because appropriate referral decisions depend on individual needs and family choice.

Where should you start building pediatrician referrals?

Complete the one-page service sheet and select a short list of relevant offices. Use the intake call script to make sure your team can deliver the handoff you describe.

For the broader channel plan, use the 90-day marketing worksheet. To evaluate a directory presence alongside referrals, review DrSensory listing options.

Frequently asked questions about pediatrician referrals

How do I introduce my therapy practice to a pediatrician?

Use the office’s approved process, identify the referral coordinator, and offer a concise sheet with services, ages, access, payment arrangements, and referral instructions. Ask which information the office finds useful.

Should I send patient success stories in my referral packet?

Keep general outreach focused on practice facts and process information. Patient information used for marketing raises privacy and authorization issues. HHS marketing guidance explains the distinction and limited exceptions.³

Does a physician referral guarantee insurance coverage?

No. An order or referral, network status, benefits, authorization, and other payer requirements are separate questions. Confirm the actual requirements before promising coverage or scheduling on that basis.

How often should I contact a pediatric office?

Follow its preference. A relevant introduction, a reasonable follow-up, and meaningful requested updates are more appropriate than frequent generic messages. Stop when staff ask you to stop.

Sources

U.S. Department of Health and Human Services, Office for Civil Rights. Uses and Disclosures for Treatment, Payment, and Health Care Operations (HIPAA Privacy Rule guidance, 45 CFR 164.506; content last reviewed July 26, 2013). “the Privacy Rule permits a covered entity to use and disclose protected health information, with certain limits and protections, for treatment, payment, and health care operations activities”; treatment “generally means the provision, coordination, or management of health care and related services among health care providers”, consultation between providers, “or the referral of a patient from one health care provider to another”; and “A covered entity may disclose protected health information for the treatment activities of any health care provider (including providers not covered by the Privacy Rule).” Checked October 7, 2026.
U.S. Department of Health and Human Services, Office of Inspector General. Fraud & Abuse Laws (A Roadmap for New Physicians). The Anti-Kickback Statute “prohibits the knowing and willful payment of ‘remuneration’ to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs”; “Remuneration includes anything of value and can take many forms besides cash”; “To be protected by a safe harbor, an arrangement must fit squarely in the safe harbor and satisfy all of its requirements.” Checked October 7, 2026.
U.S. Department of Health and Human Services, Office for Civil Rights. Marketing (HIPAA Privacy Rule guidance, 45 CFR 164.501 and 164.508(a)(3); content last reviewed July 26, 2013). “With limited exceptions, the Rule requires an individual’s written authorization before a use or disclosure of his or her protected health information can be made for marketing”; marketing is “a communication about a product or service that encourages recipients of the communication to purchase or use the product or service”; and “the Rule distinguishes marketing communications from those communications about goods and services that are essential for quality health care.” Checked October 7, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy practice. The HIPAA and other legal points are general information, not legal advice; your own compliance adviser is the person to ask about your practice.

How to get referrals from pediatricians with scripts and a letter template