Physician Call Center (Consults / Referrals /Transports)    (414) 266-2460    (800) 266-0366 toll-free Central Scheduling (Outpatient Specialty Appts.)    (414) 607-5280    (877) 607-5280 toll-free

Specialty Clinic Referral Forms

• Airway, Digestive and Voice Center Referral.
• Endocrine Clinic.
• Feeding, Swallowing and Nutrition Center.
• Neurogastroenterology, Motility and Autonomic Disorders.
  Note: For all other GI referrals call Central Scheduling at (877) 607-5280.
• Neurology Clinic.
• NEW (Nutrition, Exercise and Weight Management) Kids^TM Program.
• Psychiatry and Behavioral Medicine Center.
  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.
• Pain Clinic.
• Pulmonary Clinic.
• Sleep Center.

Outpatient Order Forms and Consent Forms

• Outpatient Diagnostic/Rehab Services Orders - Includes Cardiology, Neuro-Diagnostic, Pulmonary Function, Rehabilitative Services and Anesthesia.
• Outpatient Laboratory Orders - Includes commonly ordered tests of blood, urine, and stool, in addition to common cultures and drug levels.
• Outpatient Specialty Laboratory Orders - Includes infrequently ordered specialty tests of blood and urine.
• Outpatient Radiology Orders - Includes General Radiology, Fluoroscopy, CT Scan, Nuclear Medicine, PET/CT, MRI/MRA Scans and Ultrasound.
• pH/Impedance 24 Hour Study Order - Used to order the pH Impedance Study.
• HIV Testing Documentation - Used to document verbal consent for HIV Testing.     

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