Referring a patient to the Cancer Center of Western Wisconsin?

If you or a loved one has been referred to the Cancer Center, click here for a printable referral form.

With this form please attach the following documents:

  • Most recent health history and physical examination results from the primary physician
  • Dictations or notes
  • Operative or surgical reports
  • Procedures/labs/imaging (CT, PET scan, ultrasound, MRI) (last 6 months)
  • Pathology reports
  • All history pertaining to cancer or hematology diagnosis
  • Current medication list/allergies
  • Demographic/Face sheet

Once completed you can fax the completed form to (715) 243-2801.

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