For Healthcare Providers

Information for Healthcare Providers in Iowa

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

We 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 the clinic page or call:

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.

Pella Clinic Pella Referral Form 641.621.1493


Consent to Contact – PMAD Patients

Many women are anxious to call Pine Rest regarding perinatal mood and anxiety disorders, even if you have referred them. If you have your patient complete and sign our Consent to Contact Form, we will assess their situation and recommend the level of services needed.

New Client Forms

Clients must complete a New Client form before their first appointment. These forms can now be completed online! Printable forms are still available. You can print out the appropriate form for your patients, if you wish, and instruct them to bring the completed New Client form to their first outpatient visit.  All New Client forms are available from our Iowa page. 

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.

Free Materials Available

To order any of the available materials for your office, please use our Online Materials Request Form or call us at one of our clinics.