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Appointment Requests

You are worthy of your own investment. I offer a sliding fee scale ranging from $120 to $150. I can provide a Superbill for services to present to your insurance. Medi-Cal FSS accepted.

Please complete the appropriate intake form and request form below to request an appointment for services. I will contact you as soon as possible to find a mutually convenient day and time. 

Intake Forms

Print and complete the appropriate intake form. Scan the completed form and upload the signed form. 

To e-fill & sign, you need Adobe Acrobat. Download here:

If you are unable to complete the form(s) online, bring the completed form(s) to your appointment.

Contact Details

6135 King Road, Suite B
Loomis, CA 95650

916-572-4484

mayalatherapy@gmail.com

Request an Appointment

Preferred Date and time
Month
Day
Year
Time
HoursMinutes
Appointment Type
Adult
Minor
Couple
Family
Service Requestion
In-Person
Telehealth

Please do not submit any Protected Health Information (PHI).

By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

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Information by MELANIE AYALA Sacramento Therapist

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