Below please find the forms needed to be signed prior to your first appointment:

Intake Form (fill this form to the best of your knowledge)

Telemedicine Consent

Telemedicine Information

Receipt of Notice of Privacy Practice

Payment Consent and Credit/Debit Card Information

Release of Information

Treatment Consent


I usually videotape my psychotherapy sessions with my patients. I always review the video tapes to improve the quality of the psychotherapy treatment and will discuss them with you. Of course, this will not be done unless you sign the following form:

Video Recording Consent for Therapy


Below please find my practice Notices of Privacy Practices. This document can also be mailed to you upon you request.

Notice of Privacy Practice


Dr. Jazi's Practice Fees:

Dr. Jazi opted out from Medicare, effective July, 1st 2021. He doesn't accept insurances. However, Dr. Jazi can provide a superbill for you to get reimbursed by your insurance, if applicable.


Below, please find the service fees. Discounts are available upon request.


Initial evaluation (first time visit):

$400 for 60 minutes.

Initial evaluation with comprehensive cognitive evaluation (first time visit):

$600 for 90 minutes.

Follow up sessions:

$200 for 30 minutes follow-up.

Psychotherapy sessions:

$250 for 45 minutes of psychotherapy. $500 for 90 minutes of psychotherapy.