Online Referral Form


  • Introduction
  • Online Referral Settings
  • Creating the Online Referral
  • Online Referral Website Configuration
  • Using the Online Referral Form
  • Referral Email Alerts


The days of entering in basic information for new referrals are over! Our online referrals form allows agencies to create online referral forms that can be embedded on their public website! From there, visitors fill out the referral form which is then automatically added to the extendedReach system as a new, pending referral.

If you have a question not addressed here, you can search at the bottom of this article in Related Articles or you can contact support at 

Online Referral Settings

The online referral form is a Program Report Type that utilizes the Custom Form Builder to ensure for agency customization and to help meet specific program needs.

To get started, go to Program Settings -> Program Report Types -> Add Program Report Type. In the Configuration section, select “Use Custom Form Builder”, once selected, click on “Show Advanced Options” and enable the setting “Online Referral Form (advanced)”.

From there, click on the Custom tab to begin building your online referral form!

Image: Report setting configuration

Creating the Online Referral

On the Custom tab, use the drag and drop the fields on the right side of the screen into the “Add Fields Here” box.

You can then map certain fields to extendedReach (e.g. first name, date of birth, religion, gender, etc.). To map the fields, click on the “Save to Referral” drop down box and select the appropriate field.

Image: Referral custom form

Mark certain fields required by checking the box next to “Required”. All required fields will show a highlighted yellow label in the custom form builder.

Image: Custom form required fields

Field codes can also be used auto-fill text in the custom form builder. Field codes can either be placed in the fields or used as help text.

Image: Using field codes in the custom form

Once the form has been created and finalized, it’s time to put it to use!

Online Referral Website Configuration

On the General tab of the report settings of your online referral, scroll down to the Online Referral Configuration section.

The first required setting is to select which organization the referral form applies to.

Image: Default organization setting

In this view, you can select a default worker for all incoming, pending referrals.

Image: Assigned worker configuration

Underneath the Default Staff and Default Organization setting is the Acknowledgement section. When a new referral submits the form, they can receive a customized conformation message or can be redirected to a URL.

To provide a customized message, click on “Message” and use the message field to create your message.

Image: Acknowledgement configuration

You can also choose to redirect the user to a different page on your website. To do so, click on the “Redirect to URL” button and paste the URL into the URL field.

Image: URL configuration

To add the Online Referral to your website, copy and paste the embedded code into your website where you would like the form to appear.

Those who have knowledge of CSS, can use the “Custom CSS” field to make adjustments to the form such as adding a specific font or background color to match the website.

Image: Custom CCS configuration

Using the Online Referral Form

Once the form has been added to the website, potential referrals can begin entering in their information! When they have finished entering in their information, they will click on the Submit button which will then provide them the confirmation message or URL redirection.

Image: View of online form on website

Image: Confirmation message

Once they click on the Submit button, their information is then sent to extendedReach. You can view the new referrals by going to Case Rosters -> Referrals.

Image: New referral found in Case Roster view

Looking at the referrals profile on the General tab, you can see all the information that was inputted.

Image: Referral information

To view the complete form, go to the Case File tab -> Records tab and click on the completed Report.

Image: Link to completed referral form

Image: Completed referral form

When a new referral is submitted, the system checks for an existing duplicate pending referral for the same program. If one is found, the new referral form is attached as a report to the existing referral – preventing duplicates.

Referral Email Alerts

Notify staff of when a new referral is added by going to System Settings -> Email Alerts -> Add Email Alert.

In the Event Type drop-down menu, select “Referral Pending”. You can then select who will receive notification of the referral in the “Who should receive this notification?” section.

Image: Referral email alert