Specialty Clinic Referral Forms
Children's Hospital of Wisconsin offers specialty services to referring physicians. Physicians must complete a referral form for the clinics listed below. To obtain the form click on the name of the appropriate program desired from the list below.
Neurology specializes in seeing patients presenting with the following conditions: seizures, headaches, tics, tremors, ataxia, hypotonia, microcephaly, macrocephaly, brachial plexus injury, Tourette's syndrome or muscular dystrophy.
Neurology does not specialize in the following conditions: ADHD/ADD, autism, behavior problems, behavioral difficulties or problems in school (suboptimal/academic school performance). Please refer these patients to Child Development or Psychiatry.
Psychiatry and Behavioral Medicine Center
Psychiatry and Behavioral Medicine provides mental health diagnostic and treatment services to children and families through a variety of methods. The entire range of childhood mental illness is addressed. Comprehensive treatment for primary substance abuse problems is not available at this center.
Due to special requirements for mental health referrals, the parent must contact the Psychiatry and Behavioral Medicine Center once the referral has been faxed to complete the intake and scheduling process. Privacy laws prohibit us from contacting the patient/parent to follow up on an incoming referral.
Our clinic sees patients by appointment only. In case of a psychiatric emergency, advise your patients to go to the nearest psychiatric hospital or any hospital emergency room immediately. If the patient is an immediate threat to himself or herself (suicidal or homicidal), call 911. In Milwaukee County, three psychiatric crisis resources are:
- 24 hour crisis line - (414) 257-7222
- Mobile Urgent Treatment Team (MUTT) - (414) 257-7621
- Psychiatric Crisis Center
9499 Watertown Plank Road
(414) 257-7260
Endocrine Clinic
Pediatric Endocrinology provides high quality, comprehensive care to children with the most common to the most challenging endocrine conditions, with services that focus on delayed puberty, failure to thrive, growth hormone deficiency, other endocrine gland condititons, polycystic ovary syndrome, precocious (early onset) puberty, rickets, short stature, thyroiditis, and type 1 and type 2 diabetes.
Pediatric Endocrinology is comprised of four board certified pediatric endocrinologists and five advanced practice nurses. We remain one of the largest diabetes centers nationally, caring for more than 1,500 children with diabetes and their families.
Pulmonary Clinic
The Pulmonary Clinic provides the highest quality of services for children with a variety of common to complex pulmonary conditions. Our pulmonary team of physicians, fellows, research-associates and nurses provides comprehensive evaluation and management for children with asthma, recurrent pneumonia, chronic cough, infant apnea and chronic lung disease, cystic fibrosis, and congenital or acquired airway problems.
The Sleep Center is a comprehensive program for helping children with sleep disorders. The Pediatric Sleep Disorders Clinic sees children with respiratory, non-respiratory and behavioral sleep disorders. Some children require only behavioral intervention. Other children may need further evaluation in the sleep laboratory to diagnose and treat their symptoms.
Symptoms that often require a referral include: loud snoring, apnea, difficulty breathing during sleep, difficulty waking up in the morning despite getting what seems to be enough sleep, difficulty initiating or maintaining sleep, falling asleep in school, frequent nightmares, night terrors or sleepwalking.
The Feeding, Swallowing and Nutrition Center provides complete evaluation and treatment for children and adolescents with feeding and swallowing disorders. The Center provides a comprehensive team approach with gastroenterologists, nurse clinicians, dietitians, behavioral health psychologists, speech language pathologists and social workers partnering with families to diagnose and manage: behavior related to feeding issues, failure to thrive and weight loss, motility problems, oral sensorimotor and swallowing problems. The Center does not treat feeding disorders such as anorexia or bulimia.
After you make a referral, our staff will contact the family and begin the scheduling process. This includes conducting a phone interview and asking the family to complete medical and behavioral health inventories and to provide a diet history. Following the completion and return of the paperwork an appointment is arranged within four to six weeks.
The GI Motility and Functional Bowel Disorders Program of Children's Hospital of Wisconsin, one of only a handful of pediatric motility programs in the country, provides consultative and diagnostic services for infants, children and adolescents who have a variety of disorders resulting from abnormal movements or sensation in the gastrointestinal tract. Referrals are made to the program from throughout the United States and abroad.
After you make a referral and provide clinical documentation, our staff will contact the family and begin the scheduling process. This includes conducting a phone interview and asking the family to complete health inventories. As many of the referrals to us have complex medical needs and may be traveling from a distance, our staff may also contact you to obtain additional medical information. Once the information is obtained and we have developed a preliminary treatment plan, an appointment will be arranged.
Cardiac Cath Lab at the Herma Heart Center
The Cardiac Cath Lab at the Herma Heart Center performs diagnostic, interventional, and electrophysiological procedures on pediatric and adult patients with congenital heart disease, and pediatric patients with acquired heart disease. Any patient in need of a cath procedure must be referred by a pediatric cardiologist.
Airway, Digestive and Voice Center
The Airway, Digestive and Voice Center coordinates care for children with complex aerodigestive abnormalities which impact breathing, voice, swallowing and feeding. Some of the common reasons for referral are: airway evaluation, bronchoscopy, airway reconstruction, airway obstruction, voice disorders, persistent coughing and vascular anomalies of the head and neck.
NEW (Nutrition, Exercise and Weight Management) KidsTM Program
The NEW (Nutrition, Exercise and Weight Management) KidsTM Program is dedicated to caring for children with medical complications associated with obesity. Please follow the above link to learn more about the referral process and the NEW Kids at the Y Program.
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