Online referral

Thank you for choosing to trust Lucas Dental Care with your patient. The details you provide will be sent to us securely through our website.

Click or drag files to this area to upload. You can upload up to 4 files.
Please give as much information as possible regarding your referral (behavioural, trauma related etc) Is the patient special needs? Is the patient nervous?

**On submission of this form, please wait to see the confirmation screen. If there is no confirmation we have not received the referral.**