STEP 1 - Fill out the Referral Form

Please click on the link below to complete our referral form.  

This form will provide us with demographic information to create a profile.  All fields are not required but encouraged to be filled. 

No information is shared with any third party entity and all data entered is SECURE and HIPAA compliant.

**PLEASE REVIEW**

Wisconsin HIPAA Notice -  What we  do with your PHI - Click to View

STEP 4 - Sign the Service Agreements

Complete and sign the Service agreements. 

The 1st one is for in-person services.

The 2nd is TeleHealth Services

(Please note BOTH forms need to be completed until forms can be migrated)

No information is shared with any third party entity and all data entered is SECURE and HIPAA compliant.

​​**PLEASE REVIEW**

Discharge Policy - Click to View

**PLEASE REVIEW**

Payment Agreement for Services - Click to View

All documents once submitted, signed and completed documents will be sent to our office.  Upon review our administrative team will contact you within 24 hours of receipt to confirm and advise of the next steps.

Thank you for your consideration.

Please look to complete the following forms (starting with STEP 1) to begin you inquiry.  
(Also note services will not begin until document compliance and insurance verification has been completed.)  Once all the forms are completed you will receive a live call from our office to confirm documents completion, insurance compliance, counselor availability and if any additional information is required.

​​​**PLEASE REVIEW**

Client Rights and the Grievance Procedure for Community Services - Click to View

STEP 3 - Sign the Acknowledgement

Complete and sign this form acknowledging you've been provided and reviewed the documents in STEP 2​

No information is shared with any third party entity and all data entered is SECURE and HIPAA compliant.

​​Family Healing and Wellness Center LLC

"Stop Hurting, and Start Healing"

3970 N. Oakland Ave, Suite 402    phone: (414) 367-8793   fax: (414) 236-6657 email: admin@fhwcllc.com 

STEP 2  - Review the Documents

Please take a moment and review the documents listed below.

Once you've reviewed the documents, you can download and retain them for your records.  Then complete the document in the next step to acknowledge that you've reviewed them.

Would you like to start Counseling?


Forms and Documents

At Family Healing and Wellness Center we are always looking for ways to make therapy accessible for all.  We've found that although traditional face-to-face therapy is the preference of many, there is a need for people to have the ability to speak with a counselor when mobility is limited.  Looking to keep the focus on moving forward, we've looked into technologies and methods to make it as easy as possible to be linked with a Therapist within our group. 


FHWC now offers TeleHealth which the ability to speak with or video conference Therapy sessions.  We offer these services generally but now especially during the COVID-19 environment. 


In urging people to stay inside, we are aware this can be a challenging time of uncertainty, anxiety, and weariness.   If you'd like to check for a Therapist to be seen immediately or have questions, please call our offices.  Our phone service is still available Monday-Friday 10am - 5pm. 

You can also be added to our wait list to be seen for services by completing the following forms.

(at the time in office services are discontinued until further notice in an effort to reduce the spread of the COVID-19 virus)

Family Healing and WellnessCenter

STOP HURTING AND START HEALING.