Nominate someone for a FPHS Community Recognition Award CLICK HERE to download the Nomination Form (pdf format)
 
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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 an fphs Clinic near you
 Form    
Collaborative Contraceptive Approval and Delegation:
Choose a county from the menu, then click the button (to the right) corresponding to the document format you wish to download.		    
Wisconsin Medicaid Presumptive Eligibility Waiver
("Family Planning Waiver form")		 HTML Word
Client demographic information HTML Word
Birth control supplied by mail HTML Word
Pill Pick Up Permission Slip HTML Word
Presentation Request Form HTML Word
Change of name and address form HTML 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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