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Effective therapy by US-licensed psychologists in Seoul!
You&Me
Psychological and COnsultation
Services (YPCS)
Please try to complete all the questions that are asked in this form. YPCS staff will contact you as soon as we see the form completed.
We look forward to working with you!
Schedule Appointment
Legal Name
*
First
Last
[object Object]
Address in Korea
*
Cellular Phone Number
*
Gender
*
Male
Female
Email
*
Birthday (MM/DD/YY)
*
Country of Origin
*
Please let us know what you hope to address in therapy. (example. depression, anxiety, adjustment, identity issues)
*
I am interested in receiving...
*
Individual Therapy
Couple Therapy
Parenting/Underage Child Therapy
Psychological Testing
I would like to schedule an appointment on the following day(s)- Please pick multiple days if possible.
*
Monday
Tuesday
Wednesday
Thursday
Saturday
I prefer to schedule an appointment during ______ of the day.
*
Morning (10am-12pm)
Afternoon (1pm-4pm)
Evening (5pm-8pm)
I have received therapy in the past.
*
Yes
No
Not Sure
If you have a foreign health insurance plan, please write the name of the policy.
*
How did you find out about us?
*
* 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
*
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.
Submit
Home
About
Services
Psychological Testing
Schedule Appointment
Testimonials
FAQ
Contact Us
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