We just wanted to take a moment to familiarize you with the process of referring clients to our care.

1) Providers are welcome to (but not required to) call our office and give us a heads up that the referral is coming.

2) Providers can fax a referral form (attached) to our office with dx code specified (helpful for billing purposes). If a diagnosis has not yet been made, the client will be offered a 30 min screen with one of our Evolve therapists where a diagnosis can be screened for.

3) Client/family is encouraged to call our office to schedule an intake appointment with a dietitian and/or therapist. Appleton Office: 920-364-9078 or De Pere Office: 920-570-6339

Please note: If referring clinician would like to receive records from our office, please ensure client/family signs a release of information upon your referral (otherwise we will not be able to disclose client followed up and called us for an apt).

We highly value your referral and look forward to working with you!

Dietician Referral Form

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