PATIENT FORMS

All Sayana Medical & Wellness providers and staff work together to pool expertise with the end goal of providing the best integrative care for our patients.

nEW pATIENT fORMS

Please complete all orange links below prior to your first appointment at Sayana Medical

Reboot Program Forms

Please complete all Reboot Program forms prior to your first reboot appointment at Sayana Medical

Sayana Forms

New Patient Form

View and Complete Form

Sayana Forms

Reboot Program: New Patient Form

View and Complete Form

Sayana Forms

Medical Records Request Form

View and Complete Form

Sayana Forms

Reboot Program: Health Questionnaire

View and Complete Form

Sayana Forms

Hippa Privacy Form

View and Complete Form

Sayana Forms

Hippa Privacy Form

View and Complete Form

Sayana Forms

Medical Symptoms Questionnaire

View and Complete Form

Sayana Forms

Telehealth & Electronic Communication Form

View and Complete Form

Sayana Forms

Generalized Anxiety Disorder
(GAD-7)

Mental Health Questionnaire

View and Complete Form

Sayana Forms

Patient Health Questionnaire
(PHQ-9)

Mental Health Questionnaire

View and Complete Form

Sayana Forms

Telehealth & Electronic Communication Form

View and Complete Form

FREQUENTLY ASKED QUESTIONS

How can we help? Contact us anytime from 8 am – 5 pm Monday to Friday PT USA (818) 331-4386
We are happy to be your primary care provider and take care of your wellness and follow-up needs through a lens of functional and internal medicine. We are the primary care providers of approximately 80% of our patient panel and the rest have another primary care provider but see us for functional medicine consults.

We accept various PPOs and Medicare. You will be responsible for any deductible per your insurance plan.
Please check your insurance if you have met your deductible. If your deductible has not been met, for all upcoming visits the following estimated payment amounts will required at time of service:

For visits with medical providers:

  1. New patient visit: $150 (Deductible amount)
  2. Follow-up visit: $100 (Deductible amount)
No, you don’t. Our main approach is lifestyle change through better nutrition, sleep quality, elminimation and stress management. We do extensive testing to see if you are absorbing your nutrients, have any gut issues affecting absorption or not getting enough quality nutrients. Based on these we may recommend supplements or prescription medication to improve these for a short amount of time.
A lot of our patients address all their clinical questions during face to face visits with our providers. We understand that some patients prefer more access between visits and we provide that at an additional fee, which can be paid monthly or annually. For patients with multiple medical conditions, this is a great added service as they can be in touch with their practitioners at Sayana Medical using our messaging app. We will usually respond to you within 72 hours or less.

Sayana Medical and Wellness Center use Spruce: The Digital Care Platform that allows you to communicate with your doctor between visits

Spruce is HIPPA compliant so you have the comfort of knowing that your communication is encrypted and secure.

You can also send and receive Photos, Videos calls or health questionnaires on spruce

Spruce is available to use through Apple or Android phone app or you can use your computer internet browser

For a monthly Fee of $65/month, pay for the months you need it, or $650/12 months pay one time for the year.

Benefits are ..

  • Unlimited messaging for clinical questions unless your Provider determines that a visit is needed
  • Direct communication with Dr Sayana
  • Ask any questions on supplements or medications between visits
  • Be seen quicker it is determined that you need a visit
  • Review basic labs via messaging without a follow up appointment
  • No contract to join, so you can join for a month and decide its not for you and stop without penalties

Please Ask one of our staff for more information.

Most of the basic laboratory tests are covered with your insurance, but it depends on your deductible. We provide cash prices for all the labs we draw. We also offer functional medicine testing that is not fully covered by insurance but we try to provide upfront transparency as to what those costs could be.

Yes, we have many patients that pay us directly without going through insurance.

 

Provider cash prices
 
MD: Dr.Sayana: 
 
  • New patient (45-60min): $429
  • Follow-up (20-30min): $309
  • Follow-up PLUS or w/ Physical (30-45) $359
  • Follow-up EXTENDED (45-60min) $389
  • Urgent/ Controlled sub refills (10-15min) $ 150
 
NP/PA: Serena PA-C, Sara FNP-C
 
  • New patient (45-60min): $ 389
  • Follow-up (20-30min) $ 279
  • Follow-up PLUS or w/ physical ( 30-45min): $329
  • Follow-up EXTENDED (45-60min): $349
  • Urgent/Controlled Sub refills (10-15min): $120 
 
Reboot Weight Loss program:
 
  • Initial Appointment: $507
  • 1 Metabolic support cleanse 
  • 1 Provider Consultation (45min)
  • 4 Kick start plus injections (lipo+ b 12 )
 
Optional add on
 
  • $30: BIA
  • $50: EKG
 
Reboot Follow-up:
 
  • $387
  • 1 provider consultation (30min) + 1 Kick start plus injection (Lipo + b12)
 
Optional add ons
 
  • $30: BIA
  • $50: EKG
  • $90: Metabolic Support Cleanse 
  • $300: 6 Fat Burner plus energy shots: 15% off if bought as a bundle.
  • $180: 6 Lipo injections: 15% off if bought as a bundle. 

Lab Fees: Varies depending on what tests are ordered + $25 venipuncture fee. For patients with PPO insurance and MediCal patients, some labs may be covered through insurance.

For various IV therapies and injection therapies pls refer to IV/Injection web page.

We complete disability forms for patients but you would have to be an established patient with us for at least a 6 month time period.

If you have any further questions, feel free to contact us using our form here or call us on 818-331-4386.

FAQ