Referral Agent Client Permission Form For Sharing Contact Information

If you refer business, you're holding something valuable: a client's trust. That trust can disappear fast when a client gets a call they didn't expect.

A referral consent form helps you avoid that awkward moment. It confirms, in writing, that the client wants you to share their contact information with a specific professional (or a short list of options). It also documents what the client agreed to, and how they want to be contacted.

For a Referral-Only Real Estate Agent, this is part of staying helpful without stepping into active representation or messy follow-up.

When you're a referral agent, your job is simple: connect people. Still, the handoff can create risk if it's informal.

First, clients often forget what they said "yes" to on a quick call. A written permission form reduces confusion, especially if the receiving agent reaches out days later.

Second, sharing contact information can trigger privacy and communication concerns. Some clients are fine with a call, but don't want texts. Others will accept one introduction but not ongoing marketing. A good form lets the client set boundaries.

Third, referrals often include a referral fee. Even when disclosure rules vary, transparency protects relationships. A short sentence stating you may be compensated keeps the tone clean and professional.

Finally, written consent helps with recordkeeping. If a dispute comes up, you can point to a signed document instead of memory.

If you're building a referral-only model, it also helps to understand how these relationships typically work, including fees and paperwork expectations. See the Direct Connect Brokerage FAQ for practical context around referral-only workflows.

A strong referral consent form is short, clear, and specific. It shouldn't read like a contract written for a courtroom. Instead, it should sound like what it is: permission to share contact details for a referral.

Here's what your form should cover:

• Who is sharing the info (you and your brokerage, if applicable).
• Who will receive it (the agent, lender, insurance pro, attorney, or vendor).
• What will be shared (name, phone, email, and any notes the client approves).
• Why it's shared (to contact the client about buying, selling, financing, coverage, or a related service).
• How contact can happen (call, email, text, and preferred times).
• Whether marketing is included (optional, separate checkbox).
• How long consent lasts (an expiration date is clean and client-friendly).
• Single-referral limitation (optional, but many clients like it).
• How to revoke consent (a simple contact method).

Before the form, set expectations in plain language: "I can introduce you, but I won't be involved in negotiations or the transaction." That keeps your referral role clear.

To help you think about scope, here's a quick reference.

The takeaway: share only what helps the referral professional serve the client, and keep everything else out unless the client explicitly approves.

If you want examples of how real estate regulators present written disclosures, review your state's forms and bulletins. For example, North Carolina provides guidance on agency disclosures in its Working With Real Estate Agents disclosure update. Even though agency disclosure is a different topic, the writing style is a good model: clear, direct, and consumer-focused.

Use the template below as a starting point. Privacy, telemarketing, and consent rules vary by state and by communication method, so have your broker, counsel, or compliance team review before you adopt it.

Client (Person Giving Permission)
Full Name: ________________________________
Phone: ____________________ Email: ____________________
Preferred Contact Method(s): [ ] Call [ ] Email [ ] Text/SMS
Best Time to Contact: ________________________________

Referring Professional (Person Making the Referral)
Name: ________________________________
Company/Brokerage (if any): ________________________________
Phone: ____________________ Email: ____________________

Receiving Professional (Person/Company Getting Client Info)
Name: ________________________________
Company: ________________________________
Phone: ____________________ Email: ____________________
Service Type: [ ] Real Estate [ ] Mortgage [ ] Insurance [ ] Other: ____________

Permission to Share Contact Information
I authorize the Referring Professional named above to share my contact information with the Receiving Professional listed above for the purpose of discussing my needs and providing services.

Information authorized to share (check all that apply):
[ ] Name
[ ] Phone number
[ ] Email address
[ ] General needs summary (example: timeline, location, price range)
[ ] Other (describe): ___________________________________________

Single-Referral Limitation (Optional)
[ ] This consent is limited to the Receiving Professional named above only (no additional referrals or transfers).
[ ] The Referring Professional may share my info with up to ____ alternate professionals if the first professional is unavailable.

Communication Consent (Optional)
[ ] I consent to be contacted by the Receiving Professional for referral follow-up and service-related communication.
[ ] I consent to receive marketing messages (non-service related) from the Receiving Professional.
[ ] SMS/Text consent: I agree the Receiving Professional may text me at the number provided. Message and data rates may apply. I can reply STOP to opt out (where supported).

Referral Compensation Disclosure
[ ] I understand the Referring Professional may receive compensation (such as a referral fee) if I choose to work with the Receiving Professional and a transaction closes, where permitted.

Expiration and Revocation
This consent expires on (date): ____ /____ /______ (leave blank for 12 months from signature, if allowed by your policy).
I may revoke this consent at any time by contacting: ________________________________ (email/phone).

Client Signature: ________________________________ Date: ____ /____ /______
Referring Professional Signature: ________________________________ Date: ____ /____ /______

Present the form before you send the client's info. If you're doing a warm intro by email, get the signature first, then send the introduction.

Next, store the signed form with your referral records. Keep it in the same place you store referral agreements, notes, and status updates. Save it as a PDF, and name files consistently (ClientName, ReceivingPro, Date).

Also, document what you actually shared. If you only shared a phone number, your notes should match that. When in doubt, share less.

For additional perspective on state disclosure practices, you can review examples such as Delaware's Consumer Information Statement for real estate agency relationships or Maryland's Consent for Dual Agency form. These forms aren't referral consent forms, but they show how regulators expect consent and disclosure to read: plain, specific, and signed.

A referral is like handing a friend the right phone number. Done well, it feels helpful and calm. Done poorly, it feels like their information got passed around.

Use a simple referral consent form , keep your records tidy, and let clients set contact limits. Then your referral business can grow without creating stress for you or your clients.