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EFFECTIVE THERAPY BY US-LICENSED PSYCHOLOGISTS IN SEOUL!
Please try to complete all the questions that are asked in this form. Our staff will contact you as soon as we see the form completed.
We look forward to working with you!
Schedule Appointment
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Legal Name
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First
Last
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Address in Korea
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Cellular Phone Number
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Gender
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Male
Female
Email
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Birthday (MM/DD/YY)
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Country of Origin
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I would like seek services in ______.
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Seoul (HapJeong Station)
PyeongTaek (YonSei Dawoom Hospital)
I am interested in receiving...
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Individual Therapy
Couple Therapy
Parenting/Underage Child Therapy
Psychological Testing
Please let us know what you hope to address in therapy. (example. depression, anxiety, adjustment, identity issues)
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I would like to schedule an appointment on the following day(s)- Please pick multiple days if possible.
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday (Only in Seoul)
I prefer to schedule an appointment during ______ of the day.
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Morning (10am-12pm)
Afternoon (1pm-4pm)
Evening (5pm-8pm: Only in Seoul)
I have received therapy in the past.
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Yes
No
Not Sure
If you have a foreign health insurance plan, please write the name of the policy.
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How did you find out about us?
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* At least
24 hour-notice
is required for cancellation of the scheduled session or you will be
charged the full fee for the missed appointment.
24-hour cancellation policy
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I hereby acknowledged that I read the YPCS's 24-hour cancellation policy.
Thank you for answering the questions. We will contact you as soon as possible to set up an appointment.
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Home
Therapists
Services
PyeongTaek Office
Psychological Testing
Schedule Appointment
Testimonials
FAQ
Contact Us
