Iowa Specialty Hospital

Pain Management (Interventional): Pain Management Patient Forms

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In an effort to improve your experience with Dr. Wells and her team, we are requesting that you fill download and fill out one of the packets of information below in its entirety and return it to our scheduling team. Once they receive your completed packet, they will call you to schedule your appointment with Dr. Wells. The information is needed in advance so Dr. Wells has an opportunity to review your information prior to your appointment.

Please complete and return the attached documents as soon as possible with one of the four following methods:

  • Fax the entire packet directly to our scheduling team at fax # 319-538-0434. - Preferred Method
  • Upload the completed documents to your computer, save them, and attach the saved file to an email and send it to the following email address:  You can also do this from any portable device with email applications installed.
  • Drop your packet off at any ISH location and have them fax it to the above-listed fax number. Location include: Ames, Boone, Belmond, Clear Lake, Des Moines, Fort Dodge, Garner, Hampton, Rockwell, and Webster City.  For Clarion, you can deliver it to the Specialty Clinic.
  • Return the packet by traditional mail. If you have opted for this method upon initial conversations with our scheduling team, please use the pre-labeled envelope provided. If you did not receive an envelope,  place your completed packet in an appropriately sized envelope and return it to the following address:

    Attn: Specialty Clinic Scheduling Team
    Iowa Specialty Hospitals and Clinics
    1316 South Main Street
    Clarion, IA 50525


Click on the links below to get started.

Migraine Packet

Pain Packet

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