American Family Children's Hospital

Request information

Request Information About the Faint and Fall Clinic

UW Health's Faint and Fall Clinic in Madison, Wisconsin draws on the combined expertise of specialists in cardiovascular medicine, geriatrics and neurology.


To request more information or set an appointment, complete the form below. Clinic staff will contact you with further information.


Please do not submit urgent questions about your medical care through this website. If you are experiencing a life- or limb-threatening emergency, call 911. If your need is urgent, call your clinic for assistance.





Phone Number (including area code)

HomeWork Cell


Best Time to Call



e-mail Address


Patient's Physician


Physician Practice Location


Has the patient had a recent trauma associated with the faint or fall?


Does the patient have a family history of sudden cardiac death at a young age or premature heart disease?


Which of the following diagnoses has the patient received?