Patient Forms

Who can be assessed?

Testing is offered for those over the age of 5, although it is often advantageous to wait (if possible) until age 7. This allows us to use a wider variety of assessments.
Do I need a referral?

Heartland does not require a referral for testing services.
Where do you offer testing?

Testing is offered in our Pella office only. The Pella office is located at 2611 Washington St, Pella, IA 50219.
What does testing cost?

Everyone's insurance plan is different, and the out-of-pocket cost will vary based on your coverage. The Insurance Worksheet for Psychological Testing walks you through the process of contacting your insurance to determine what your out-of-pocket cost will be. Rates for testing vary based on age and specific tests used.
Rate Estimates (before insurance):

5-6yr/old - $1,226.00 7-17yr/old - $1,572.00 18+yr/old - $1,745.00
I have Medicaid. Can I be tested?

While we can accept Medicaid for therapy services, at this time we cannot submit to Medicaid for testing. You may still be tested but will be responsible for covering the full out-of-pocket cost at the time of service. See rates above.
What if I have non-Medicaid primary insurance, but I have Medicaid as a secondary insurance?

As long as the primary insurance is one that our psychologists are credentialed with, we can submit testing claims to your primary insurance. We still cannot submit to Medicaid, so you will be responsible for any amount your primary insurance does not cover.
Are there any resources that can help me cover the cost of testing?

Heartland is now accepting Care Credit as a payment option, which can offer the opportunity for repayment over time. See the link under "Resources" or click HERE to learn more.

In order to save time at your first appointment, you can complete the new patient forms ahead of time. Click on the tab below that best describes the service you have been scheduled for, and complete all the forms in your dropdown menu.

Please note that our office needs to receive digital forms at least 48 hours prior to your appointment so we have time to process them. If you are unable to complete the online forms within that time frame, please come 30 minutes early to your scheduled appointment to complete the necessary paperwork in office. If forms are not completed prior to your appointment, it may need to be rescheduled.