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Outpatient Mental Health Clinic Intake

Outpatient Mental Health Clinic Intake

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Start the Process Today

As the need for mental health care has steadily increased in recent years, Wellpoint Care Network’s outpatient clinic has stood at the ready. We provide therapeutic support for a variety of mental health needs and accept a variety of insurance options, including Medicaid.

Wellpoint Care Network’s Outpatient Clinic is located at 8901 W. Capitol Dr. in Milwaukee, Wisconsin and is open Monday through Friday 8 a.m. to 7 p.m. If you have any questions, please do not hesitate to call us at 414-465-5770 or Contact Us.

New Patient Paperwork

Our clinicians look forward to working with you as you embark on your healthcare journey. To help speed up the intake process, you can complete your New Patient Paperwork (in English or Spanish) online prior to your first visit.

Anyone under the age of 18 will need a parent or guardian to complete and sign on their behalf.

The New Patient Disclosure Forms available below will provide you with helpful information about our Outpatient Clinic policies, as well as our strict adherence to HIPAA Privacy Practices. Please review thoroughly prior to signing your online intake form.

COMPLETE ONLINE INTAKE FORMS (English)
COMPLETE ONLINE INTAKE FORMS (Spanish)
READ NEW PATIENT DISCLOSURE FORM (UNDER 18)
READ NEW PATIENT DISCLOSURE FORM (18+)

Frequently Used Forms

Below, we’ve collected the most frequently-used forms and other healthcare-related documents for your ease of access. If you are looking for something specific not listed here, please call us at 414-465-5770 or Contact Us.

Combined Notice of Privacy Practices
Wellpoint Care Network is committed to maintaining the privacy of your Protected Health Information. Certain services we provide are subject to the federal confidentiality law for substance use disorder records (42 CFR Part 2). This Notice describes how medical information about you may be used and disclosed and how you can get access to this information.
DOWNLOAD FULL POLICY [PDF]          EN ESPAÑOL

All individuals who have received services at Wellpoint Care Network have the right to access their medical records in accordance with DHS 51.30. Requests for clients age 14-17 must contain client and parent signatures.
DOWNLOAD REQUEST FORM [PDF]

When you get emergency care or are treated by an out-of-network provider at an in-network care facility, you should not be charged more than your plan’s copayments, coinsurance and/or deductible.
DOWNLOAD FULL POLICY [PDF]          EN ESPAÑOL

This Notice explains the nondiscrimination provision of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability.
DOWNLOAD FULL POLICY [PDF]          EN ESPAÑOL

Read a full list of Our Policies.

More Mental Health Services

  • Outpatient Mental Health Services
  • School Based Mental Health
  • Occupational Therapy
  • Neurosequential Model (NM) Clinical Consultation
  • Comprehensive Community Services
  • Medication Management

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Wellpoint Care Network, Inc.
8901 W. Capitol Drive
Milwaukee, WI 53222

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