If you are interested in scheduling an appointment with Dr. Jaffe, please select the INTAKE FORM for child, adolescent or adult, as well as the QUESTIONNAIRE corresponding to the purpose for your request for services. All clients must complete the INFORMED CONSENT. Scan (or photo) completed forms and email to drj@sensitivetosound.com. Receipt of forms determines the date entered into the queue for appointments.

If you are in California and are a Medicare recipient, there is a new law requiring me to inform you that I am an Opted-Out provider, not contracted with Medicare, and that Medicare will not reimburse you for the cost of my services. I do not take any other insurance either, but now there is a new form requiring that we enter into a private contract for therapy services in order for us to work together. If this applies to you, please return the Medicare agreement form in addition the other forms. You can skip the legal representative or witness lines and just return with your signature where indicated. You can sign and email back to me along with the other forms.

Please note that, due to Covid restrictions, all sessions are currently being conducted online. Also, please read the FAQs sheets which explain current waiting list, costs, and other matters, especially as related to Misophonia.

For Clients in California

Please select, complete and return the CONSENT form and applicable INTAKE form. Also include the Misophonia, Tinnitus, or Hyperacusis questionnaire that addresses your situation.

For Clients Out of State (not in California)

Please select, complete and return the CONSENT form and applicable INTAKE form. Also include the Misophonia, Tinnitus, or Hyperacusis questionnaire that addresses your situation.