Appointment Request for New Clients with Nixaly at Practical Online Therapy

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Intake or Consult Request with Nixaly Yakubov for New ClientsNixaly is only accepting Private Pay clients (Out-of-Network Insurance reimbursement, or No insurance), and is available Mondays - Fridays 9am-1:45pm, and some afternoons and late evenings. Click the Right Arrow below to get started.

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Full Name* This field is required.

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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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 Nixaly 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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Other Adult Participant's Name* This field is required.

First Name

Last Name

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Brief description of your reason for starting therapy at this time* This field is required.

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Days and times you're available* This field is required.

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Book a 45 Minute Individual Intake with Nixaly (Private Pay only)

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Book a 60 Minute Couples/ Family Intake with Nixaly (Private Pay only)

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Book a 20 Minute Consultation with Nixaly (Private Pay only)

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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