Specialty clinic referral forms

Most specialties do not require a referral form, and appointments can be made directly through Central Scheduling. Forms for the specialties that require or recommend a referral form due to the complex nature of their patients are below.

*Note: Due to special requirements for mental health referrals, the parent/guardian must contact the center at (414) 266-3339 once the referral has been faxed to complete the intake and scheduling process. You now have the option to obtain the parent/guardian signature (if the patient is age 14 or older) at the time of referral to authorize the Psychiatry Center to communicate with you about the referral. Call the Psychiatry Intake line at (414) 266-3339 with questions.

Outpatient forms

In order to view the forms and consents, you must have version 4 or higher of Adobe Acrobat Reader installed on your computer.

Refer a patient

To refer a patient, contact Central Scheduling.

(414) 607-5280

Fax: (877) 607-5288
Toll-free: (877) 607-5280

Request an appointment

Physician consultation line

Staffed 24 hours a day.

  • Refer a patient
  • Discuss a case
  • Arrange a transport
  • Direct admission

(414) 266-2460

Toll-free: (800) 266-0366