Intensive Outpatient Program (IOP) Referral Form

Intensive Outpatient Programs (IOP) provides a step-up in support from outpatient treatment and provides group therapy, individual therapy, and medication management services. IOP occurs 3-4 days per week and runs approximately 9-12 weeks, depending on the program. Ellie currently offers Young Adult Psychosis IOP, Adapted Adult DBT Virtual IOP, and Adult Depression IOP programs. If you have questions about our IOP programs, please contact (651) 313-8080 (option 4).

In network insurance: UBH/Medica, BCBS, PreferredOne, UCare, HealthPartners, Aetna, America’s PPO/HealthEZ, Tricare. Insurances that do not provide coverage for IOP services: MN MA (and PMAP) and Medicare.

Client Name *

First NameLast Name

Client Preferred Pronouns:*

Client Date of Birth*

Date

Select Preferred IOP Track*

Young Adult PsychosisDepressionDBT

Name of Insurance Company*

Client Phone Number*

Please enter a valid phone number.

Client Email*

example@example.com

What is the best time to contact client?*

How did you hear about us?*