Summer is a great time to enjoy fruits and vegetables. WIC Participants can now get special checks to purchase fruits and vegetables at the Farmers’ Market. Visit http://dhs.wisconsin.gov/wic/ to learn how to apply.
 
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Links to online forms which you may download.   You may print any of these forms.   These forms can be downloaded either as a Web Page (.htm), a Microsoft Word document (.doc) or as an Adobe Acrobat (.pdf) file.

Clients should mail or fax the forms to a fphs Clinic near you
 Form    
Wisconsin Medicaid Presumptive Eligibility Waiver
("Family Planning Waiver form")		 PDF Word
Client demographic information PDF Word
Birth control supplied by mail PDF Word
Pill Pick Up Permission Slip PDF Word
Presentation Request Form PDF Word
Change of name and address form PDF Word
Family Planning Waiver / Medical Assistance / BadgerCare Application  PDF 
Gardasil Consent Form PDF
Gardasil Vaccine Information PDF
fphs Toll Free Number 1-800-246-5743
 


fphs - family planning health services, inc.
719 North Third Avenue, Wausau, WI 54401
(715) 675-9858 or toll free (800) 246-5743
email: info@fphs.org

This 'info' e-mail address is answered during usual business hours - Monday-Friday.
If your question requires an immediate response, you are welcome to call 800-246-5743 during business hours Monday-Friday. This e-mail address is not meant to answer emergency/urgent health concerns. If you are experiencing an emergency or urgent health concern, please contact your nearest Emergency Room or dial 911.

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