MyPellaHealth Patient Portal Enrollment Request

Please fill out the form below to submit your request for enrollment in the Pella Regional Health Center MyPellaHealth Patient Portal. This form is only for self-enrollment and not as a request to access another person's health care information (for this, you will need to navigate to Proxy Access Request ( and return the form and any documents to Health Information Management in person or you can contact the portal support line at 641-628-6792 or e-mail After you have filled out the form below for your own self-enrollment, you will be sent an e-mail with a logon link within two business days. If you do not receive an e-mail from, within two business days, please email The enrollment request form isn’t to be used for requesting a new patient portal password.