Submitting a Referral for a Wellness Check or Case Management Please complete the form below to submit a referral for wellness check/case management to the North Shore Health Department. Be sure to complete all the blanks on the form.
Referral for Wellness Check/Case Management Referring NameAgencyResident NameResident AddressResident Telephone NumberResident Municipality Bayside Brown Deer Glendale Fox Point River Hills Shorewood Whitefish Bay Comment/Notes Upload/Attach File Captcha : 1+2=? Answer