Chiropractic + Naturopathic Doctor

How chiropractors can build strong referral letters

By Dawn Armstrong DC   

Features Leadership Profession


Some doctors of chiropractic are exceptionally focused and multi-talented – they build successful practices quickly and effortlessly (or so it seems).

The rest of us are perhaps more easily distracted and less inclined to do more than we absolutely have to, but that doesn’t mean we aren’t motivated to achieve good patient outcomes and respectable monthly stats.

In an increasingly crowded healthcare market, it could be useful to more closely examine what sets our exceptional colleagues apart. Those who manage to attract a steady stream of new patients, week after week are skilled communicators and they don’t just talk a good game – they write a good letter and they do it with every new patient. If the big picture goal for our profession is to increase demand for our services, this looks like a winning strategy.


Even if you aren’t making the effort to touch base with every new patient’s primary healthcare provider, there are certain circumstances where we either should or must communicate in writing, including:

  • Referring out to another professional
  • Acknowledging a referral to your care
  • Discharging a referred patient from care.

Crafting an effective letter does not require you to be eloquent or creative or even inspired. You just need to follow some clear guidelines around the structure and content of the letter.  

Consider that the defining feature of a “strong” letter is that it accomplishes the mission you intended. This means you must first be perfectly clear about what the goal is.

Questions to ask yourself

  • Why are you writing this letter to this particular individual now? What’s your point?
  • Is there something mysterious going on with your patient and you need another professional’s help with their care?
  • Do you want to educate other professionals about what, exactly, chiropractic treatments can accomplish? Or, do you have a case to make for a patient to receive certain benefits – like a discounted gym membership or insurance reimbursement for a cervical pillow?

With your intent well-defined, carefully consider the content and play by the rules to produce written correspondence with attributes that will make your efforts worthwhile.

The rules

  • Permission to communicate with others about your patient’s case is absolutely required. You should make it part of the intake form.* You should also ask the patient about specific consent and take note in their file contemporaneously
  • The letter should be professional in appearance with quality paper/tasteful graphics
  • Keep it as short as possible; brevity is best
  • The content should be well-organized and accessible
  • Keep it jargon-free; use language that everyone understands.

The content
(Notice the use of the SOAP format)

  • State succinctly the purpose of the letter, based on the patient’s subjective complaints
  • Describe your objective work-ups, assessment/actions and recommendations
  • Indicate your future plans regarding management and self-care
  • If a response or follow-up is needed, provide the details.

The attributes

  • Easy to scan for relevant points; uses headings and subheadings and bullet points
  • Specific about the subject being addressed; there is no unnecessary information
  • Accurate and factual regarding clinical issues that have factored into your management and recommendations
  • Important enough for other doctors/members of the patient’s team to want to include in their charts.

When you write a letter to another professional, it’s an opportunity to build a good relationship based on your patient’s health and welfare.  So, a good rule of thumb is to use the pronoun ‘I’ only where absolutely necessary.

A strong letter increases understanding of what we do and why chiropractic is important. It should be free of boastful language and false claims; exaggerating either a patient’s condition or your capacity to treat it is unprofessional and raises suspicions that you are trying to impress rather than to inform.

Building a great reputation is not just about what we can do, hands-on, to assist with a patient’s complaints. It is also about how well we can speak on their behalf.


Communicating Chiropractic with Integrity. L. Sportelli, R. Mootz  – Topics in Clinical Chiropractic 2000; 7(4): 25-34

*“I authorize the clinic/my practitioner(s) to communicate with my other healthcare providers as deemed necessary for my beneficial treatment.  I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission.”

DR. DAWN ARMSTRONG is a graduate of CMCC and has been in practice for over 30 years. She is currently focused on promoting life-long learning and professional development and has created a continuing education course – Clinical Record Keeping: A Hands-On Approach. Learn more at

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