Referral Form

Now you can earn $100, $200 or $400 in cash for yourself. And the same amount in PerfectServe credit for your
physician friends and colleagues!

When your friend or colleague becomes a PerfectServe customer, you receive your cash award. And your colleagues receive the same amount in PerfectServe credit to apply to their new account. You both receive your awards AFTER the account you recommend becomes a PerfectServe customer, and you and your friends and colleagues are credited ONLY for the number of referred physician users who eventually sign on as PerfectServe clients.*

Required fields are marked with an asterisk (*).

Your Email*

Please provide the name, telephone, and email address of the physician(s) you are referring.
Before submitting this form, please be sure to talk to them about it, so they are expecting
PerfectServe to contact them:


I do not wish to receive newsletters or promotional messages from PerfectServe via e-mail.

PerfectServe’s No-Spam promise.

Your privacy is important to us. We will never provide your email or contact information to a third party.  We promise not to spam you and will only send appropriate e-mail messages that you’ve signed up for or opted-in to receive.

*Note: The Friends & Colleagues Awards Program is valid ONLY for new PerfectServe accounts – not for members of the same practice as an existing PerfectServe user. And the Friends & Colleagues Awards Program is not valid with any other PerfectServe discount or promotion. PerfectServe reserves the right to suspend the program at any time with or without notice.