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Refer a Patient

Refer a Patient to the Waukesha Heart Institute

Medical professionals like you have trusted our physicians to confirm, diagnosis, and treat patients who have complex heart or vascular issues for the past 25 years. We receive referrals from general physicians, cardiologists, and podiatrists from all over Southeastern Wisconsin. We are always happy to help you and your patients.

Podiatrists often ask us to test for peripheral arterial disease, which often goes un-diagnosed. Because we are endovascular experts we can often restore circulation, getting your patients back to you as quickly as possible, thereby making your treatments more effective. Because of restored circulation, we also can also help your patients avoid amputation.

The Waukesha Heart Institute strives to ensure prompt management of all patients and timely responses to our referring physicians and healthcare professional colleagues.

If you would like to refer a patient, call us at (262) 542-0074.

Please use our Referral Form below to easily refer a patient. Your patient, in most cases, can be seen within a week of calling for an appointment.

You may also fax our Referral Form to (262) 542-2803. Click here to download the WHI Physician Referral Form. [PDF]

The following checklist describes the information we find helpful when referring a patient. Please be prepared with this information when you contact the Waukesha Heart Institute/Heart & Vascular Institute.

Your contact information

Name

Address

Phone Number

Fax Number

Email

Information about your patient

Name

Birthdate

Address

Phone Number

Social Security Number

Insurance Information

Your patient’s complete Medical History and Records

Medical History

Surgeries/Procedures

Devices: type/settings

Description of your patient’s current Medications

Type(s)

Dosages

Allergies

Diagnostic Test reports plus actual films or tracings:

Cardiac Catheterization actual film plus report

Echocardiogram: actual tape plus report

Thallium Stress Test: actual x-ray film plus report

Chest x-ray, CT scans, ultrasounds: x-ray films plus report

Electrocardiograms: actual tracings if available

Electrophysiology testing: actual tracings and reports

Other