Integrated Healing Program referrals

If you are a provider or staff outside of Children’s Wisconsin requesting an evaluation for your patient to the Integrated Healing Program, use the form below. A member of our Integrated Healing Program will call your patient within 2 business days to schedule an appointment.

If you are a Children’s Wisconsin provider or staff, please enter Epic ambulatory referral to Pain Clinic.

You can visit our website or call our Integrated Healing Program Referral Line at 414-266-3955 for additional information and/or questions.

This form is not for urgent health problems or same-day appointments.

* Required fields

General information

Diagnosis information