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.