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Appointment Request With Nikia Dennis at Practical Online Therapy
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1
Intake or consult request with Nikia Dennis, LMSW
Nikia is available Tuesdays and Thursdays 6pm-9pm; and Wednesdays 5:30pm-10pm virtually, for clients in NY & NJ. Click the right arrow below to get started.
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2
Full Name
*
This field is required.
First Name
Last Name
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3
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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4
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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5
Session Type
*
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Individual
Couples
Family
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6
Other Adult Participant's Name
First Name
Last Name
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7
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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8
Days and times you're available
*
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9
Book a 20 Minute Consultation with Melanie
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10
Book a 45 Minute Intake with Melanie
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11
Book a 60 Minute Intake with Melanie
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12
Brief description of your reason for starting therapy at this time
*
This field is required.
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13
Contact Number
*
This field is required.
Please enter a valid phone number.
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14
Email Address
*
This field is required.
example@example.com
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