Contact Melia

If this is an emergency, call:

This form will securely send me your contact information. I try to respond to requests within 2 business days.

Client Information

Name

Email address

Phone number

I'm a former client

When are some good times to reach you by phone in the next few business days?

When are you generally available for sessions?

My appointments are 53 minutes and are scheduled Monday through Thursday between the hours of 10:00 a.m. and 4:00 p.m.

Who were you referred by?

Do you plan on using health insurance?

Yes No

Insurance company name

Insurance type

MN Care or Medical Assistance (PMAP) Commercial Other/I don't know

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