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You&Me Psychological and Counseling Services (YPCS)

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

* Indicates required field

Legal Name *

First

Last

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Address in Korea *

Cellular Phone Number *

Gender *

Male Female

Email *

Birthday (MM/DD/YY) *

Country of Origin *

I am interested in receiving... *

Individual Therapy Online/video Counseling Couple Therapy Parenting/Underage Child Therapy Psychological Testing (Seoul Office Only) MBSR (Feb 24-Apr 14 4:30PM-7:00PM: 8 sessions) Art Therapy (Mar 25, Apr 7, May 20)

Please let us know what you hope to address in therapy. (example. depression, anxiety, adjustment, identity issues) *

I would like to schedule an appointment on the following day(s)- Please pick multiple days if possible. *

Monday Tuesday Wednesday Thursday Friday Saturday

I prefer to schedule an appointment during ______ of the day. *

Morning (10am-12pm) Afternoon (1pm-4pm) Evening (5pm-8pm: Only in Seoul)

I prefer to see ______ level of therapist. *

Ph.D. Licensed Psychologist ( 180,000 KWN - 300,000 KWN) Master's Counselor (100,000KWN-130,000KWN) Intern/Trainee (50,000KWN-80,000KWN)

(May need to wait until Jan 2023 to see an intern therapist.)

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.

If you want to make an appointment at PyeongTaek office, please follow this link.

**Thank you for answering the questions. We will contact you as soon as possible to set up an appointment. Please expect to get a phone call from us (02-6929-3014).

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yOU&mE pSYCHOLOGICAL AND cOunseling sERVICES (ypcs)

Hours

Mon-Fri: 10AM - 9PM
Sat: 10AM - 4PM
Sun: Closed

COntact US

Tel: 02.6929. 3014
Fax: 02.6434.8013

Email

admin@ypcskorea.com
Kakao yellowID: YPCSKOREA

Bank account

479037-01-015977 (Kookmin) MinJung Doh, YPCS

Pay with PAYPAL

ADDRESS

Floor 3, 68, Ujeongguk-ro, Jongno-gu, Seoul, S Korea (03145)

Korean Webpage

Kakao Yellow ID