Let’s work together.Fill out this form and we will be in touch with you shortly. Name * First Name Last Name Email * What services are you interested in? Individual Therapy Assessment Clinical Supervision Consultation Who are you interesed in working with? Azur Jafari, PhD Haley Jones, LPC, LMHC No preference How can we help you? * Do you want to use insurance to pay for services? If so, who is your insurance provider? Insurance * Are you open to going out of network with your insurance provider to pay for services? Yes No Unsure By checking this box you acknowledge that Shift Therapy & Assessment only offers telehealth at this time. * I acknowledge Thank you!
