Client Referral
With Base Theme

"Referral Submission Form Template"

Form Integration, Reimagined: Get Started Now!
Client Referral Form Template

Our Referral Submission Form Template is designed to make the process of referring a contact to your business as straightforward as possible. Whether for services, partnerships, or job opportunities, this form captures all the necessary information to facilitate a warm introduction.

Features of this form:

  • Fields for the referrer's contact details for follow-up
  • Space to describe the relationship with the referred
  • Contact information of the referred individual or business
  • Checkboxes to indicate the reason for the referral
  • An area for additional comments to provide context
  • Consent checkbox to ensure the referred party agrees to be contacted

Responsive to all devices, the form allows for an easy referral process on the go. It's also customizable to fit your brand and can be quickly integrated into your website.

Employ our Referral Submission Form Template to enhance your networking efforts and grow your business through trusted recommendations.

Client Referral Features

Streamline Referrals
Streamline Referrals
Effortlessly refer contacts with a user-friendly form, simplifying the process for both referrers and recipients.
Capture Key Details
Capture Key Details
Gather essential information like contact details, relationships, and reasons for referral to ensure a smooth introduction.
Customizable Branding
Customizable Branding
Tailor the form to match your brand identity, creating a seamless experience for referrers and recipients.
Mobile-Friendly Design
Mobile-Friendly Design
Access and submit referrals on the go, ensuring convenience and efficiency in your networking efforts.
Consent Management
Consent Management
Securely obtain consent for contact from referred parties, respecting their privacy and communication preferences.
Boost Networking
Boost Networking
Enhance your networking efforts and business growth by leveraging trusted recommendations through our referral form template.
Client Referral Form Template
Customizable Form Fields
You can add, remove or re-arrange form fields when using our form builder app.
title (html-block)
referrer_name* (text, input)
Full Name
referrer_email* (email)
Email Address
referrer_phone* (phone-number)
Phone Number
relationship* (select, dropdown)
Your Relationship to the Referred
referred_name* (text, input)
Full Name or Business Name
referred_email (email)
Email Address
referred_phone (phone-number)
Phone Number
referral_reason* (select-multiple, checkbox)
Reason for Referral
additional_comments (text, textarea)
Additional Comments
consent* (boolean, checkbox)
Consent for Contact
thank_you_message (html-block)

Try Out the Form for Yourself!

Experience Ease and Flexibility Across Multiple Devices and Screens

The form below is using our "Base" form theme. You can change the colors and the theme using the Wizara Form Builder app.