For Healthcare Providers

Information for Healthcare Providers in Iowa

Thank you for your interest in partnering with the Pine Rest Pella Clinic to help address your patients’ mental health needs.

medical-condition-anxietyWe are committed to accepting referrals, coordinating services, and providing consultative services whenever possible. As you encounter patients who could benefit from our services, fax us a completed referral form. Our staff will contact the patient to schedule an appointment.

We participate with most health insurance plans, including HMOs. Our staff is happy to assist you or your patient with questions about coverage and payment.

To learn more about our services, please visit:

Pella Clinic – (ph) 641.628.9599

Referring Patients to the Pella Clinic

Referrals for counseling, assessments and other outpatient services are best made via fax.

OUTPATIENT CLINIC LOCATION DOWNLOADABLE REFERRAL FORM FAX NUMBER
Pella Clinic Pella Referral Form 641.621.1493
Iowa: Pregnant and Postpartum Consent to Contact Consent to Contact Fax Form 641.621.1493

 

 

New Client Forms

Clients need to bring a completed New Client form to their first visit. You can print out the appropriate New Client form form below or direct your patient to pinerest.org/outpatient to print out the form at home. The form must be completed in black or blue ink.

Information about Your Patient’s Treatment*

For information about a patient’s outpatient care, call the clinic where services are provided. If you do not know which clinic the patient received services, call 866.852.4001.

Release of Information Forms

OUTPATIENT CLINIC LOCATION DOWNLOADABLE FORM EXAMPLE FAX NUMBER
Pella Clinic Release of Information Form (Pella, Iowa) Example 616.281.6394
*In compliance with HIPAA, we can only share information with you if the patient has signed a release of information. If you are unable to get the information that you are requesting, guide the patient through completing the release of information following the example and directions provided. Fax the completed release of information to the appropriate location with a statement about what information you are requesting.