Send Us the Client's Information by Email

We maintain a secure mailbox to receive client information. You can put the information in the text of the email and you can attach information to the email.

Send referral information to

What should you include?

Start with letting us know who you are:

  • your name
  • your address for correspondence
  • your telephone numbers
  • your email
  • your company
  • your role in the case
  • your goals for the case
  • any documents or reports you may have.
    —the client can sign an AUTHORIZATION FOR DISCLOSURE OF CONFIDENTIAL INFORMATION which enables you to forward information you received from other parties as well as information you have developed.

ADULT CLIENTS

All this information helps us select the best Professional to help. Provide

  • client name
  • address
  • home, work, and cell phone numbers,
  • birthdate
  • the name of the insurance
  • and tell us about the problem – the more detail the better.

CHILD CLIENTS

For a Child who will be the client —
   If the client will be a minor, leave:

  • parents' names
  • the child's name
  • address
  • home, work, and cell numbers,
  • the child's birthdate
  • the name of the insurance
  • and tell us about the problem in as much detail as possible

TO TELL US ABOUT THE PROBLEM

  • What symptoms and behaviors are a concern?
  • What outcomes will let you and the client know progress in therapy was achieved?
  • What are the goals of you and your institution?

OTHER IMPORTANT DATA

  • primary doctor
  • psychiatrist
  • any past therapist(s) or psychiatrists(s)
  • ALL medications taken for any reason – names and dosages,
         including vitamins, herbal, and supplements
  • lawyer if client is involved in any legal proceedings
  • case manager if there is one
  • insurance card
  • previous psychological assessments
  • relevant court orders
  • records from any psychiatric hospitalizations and past psychotherapy

NOTE: If the client has Title 19, Medicaid, or Badgercare, we just need the client's social security number, not the Forward Card.

Our secure fax is: 414–540-2171.

You've made an important decision to get help for your client. Our goal is to get therapy scheduled and started as soon as possible. We hope to make this important step go as easily as we can.

Helping You Find Your Strength and Serenity


Brown Deer Office: (414) 540-2170
Waukesha Office: (262) 446-9981

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Copyright ® – Shorehaven Behavioral Health, Inc.