To improve communication in the referral process a standard referral form was composed that seeks to involve the patient in the referral process. It has been well received by the consulted physicians, the family practitioners who use it in everyday office parctice and the patients. A review of referral patterns in general practice showed many similarities from practice to practice and from country to country. Ophthalmologists were the most frequently consulted, followed by obstetricians and gynecologists, general surgeons, otolaryngologists and orthopedic surgeons. A follow-up assessment of referral outcome revealed a poor response from the teaching clinics of one tertiary-care hospital to the referring physicians. This resulted in a substantial decrease in the proportion of patients referred from one family practice unit to the hospital over a 3-year period.