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Patient Referral

Referrals to Dr Lancashire can be made by contacting reception directly (by phone, fax or email), or by submitting the Online Patient Referral form below.

On submission of this online form, a confirmation email will be sent to your nominated email address.

If you have any specific queries or concerns, Dr Lancashire would be happy to discuss them with you by phone. 

Please note: items marked * indicate mandatory fields.

GP/Specialist details
Please enter phone number with area code included. No spaces please. eg. 0298765432
Patient details
Please enter phone number with area code included. No spaces please. eg. 0298765432
Document uploads
Provide up to five relevant documents (scanned referral, certificates etc).
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf odf pdf doc docx.