Appointment Request With a Therapist at Practical Online Therapy

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Intake or Consult Request With a Therapist at Practical Online Therapy* This field is required.Enter the Full Name of the Client
First Name
Last Name
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State where most virtual sessions will be attended from* This field is required.Our therapists are licensed in NY & NJ only, so they can only see clients virtually in one of those states.
New York
New Jersey
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Select a therapist (photo will appear after you make a selection)* This field is required.
Please Select
Please Select
Any therapist at Practical Online Therapy
Nikia Dennis: T/Th 6-9, W 5-9
Melanie Joaquin: W & Th 10am-10pm, F 10am-4pm
Nixaly Yakubov: M-F 9am-1:45pm
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You have selected Melanie Joaquin.Booking with Melanie Joaquin, MHC-LP
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You have selected Nikia Dennis.Booking with Nikia Dennis, LMSW
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You have selected Nixaly Yakubov.Booking with Nixaly Yakubov, LCSW
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Days and times you're available* This field is required.
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Intake or Consult?* This field is required.
I would like to get started right away: I'd like an intake.
I would like to take my time and interview the therapist first: I'd like a 20 minute video consult.
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Session Type* This field is required.
Individual
Couples
Family
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Payment Type (Insurance or Private Pay)* This field is required.
Aetna Insurance (In-Network)
Meritain Insurance (In-Network)
First Health (Not Healthfirst) Insurance (In-Network)
Private Pay/ No Insurance/ Out-of-Network
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Image FieldBooking with Dylan Meyers, LMSW
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Image FieldBooking with Nicole Sappia-Parmigiani, LMSW
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Image FieldBooking with Melanie Joaquin, MHC-LP
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Image FieldBooking with Nixaly Yakubov, LCSW
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Book a 45 Minute Individual Intake with Nixaly (Private Pay only)* This field is required.
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Book a 60 Minute Couples/ Family Intake with Nixaly (Private Pay only)* This field is required.
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Book a 20 Minute Consultation with Nixaly (Private Pay only)* This field is required.
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Book a 20 Minute Consultation with Melanie * This field is required.
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Book a 45 Minute Intake with Melanie* This field is required.
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Book a 60 Minute Intake with Melanie* This field is required.
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Book a 20 Minute Consultation with Nicole * This field is required.
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Book a 45 Minute Intake with Nicole* This field is required.
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Book a 60 Minute Intake with Nicole* This field is required.
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Book a 20 Minute Consultation with Dylan * This field is required.
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Book a 45 Minute Intake with Dylan* This field is required.
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Book a 60 Minute Intake with Dylan* This field is required.
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Brief description of your reason for starting therapy at this time* This field is required.
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Contact Number* This field is required.
Please enter a valid phone number.
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Email Address* This field is required.
example@example.com
Should be Empty: