CCS Pauquette Referral Form

This referral is for Pauquette Center for Psychological Services, CCS contracted services.  This form should be filled out by the county’s service facilitator. Please note that at the end of this form, you will also be prompted to upload the client’s CCS Service Plan and most recent Comprehensive Assessment.  There will be an additional prompt to continue on to complete a DBT Comprehensive Referral if applicable.  If you are having problems with this form, please contact our Pauquette Whitewater office at 262-473-0670 or email  Thank you. 

Share Our Services!