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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

[object Object]

Address in Korea *

Cellular Phone Number *

Gender *

Male Female Others

Email *

Birthday (MM/DD/YY) *

Country of Origin *

I am interested in receiving... *

Individual Therapy Couple Therapy (Ph.d Psychologist only) Parenting/Underage Child Therapy Psychological Assessment Online/video Counseling Taejae University Student/Faculty Counseling

**Additional Documents (If applicable): Insurance Card, Referral Letter, Enrollment Verification Letter, Student ID, etc. *

Max file size: 20MB

If you are Taejae University student or faculty memebr, please upload your Student ID card or employment Card.

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)

Please choose all available hours.

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)

The fee may vary depending on the language, duration of session, and age (minor).

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 (Seoul)
031.651.3885 (PyeongTaek)
Fax: 02.6434.8013

Email

admin@ypcskorea.com
Kakao yellowID: YPCSKOREA

Bank account

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

Pay with PAYPAL

ADDRESS

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

[PyeongTaek Office]
Floor 3, 37-1, Anjeongshopping-ro, Paengseong-eup, Pyeongtaek-si, Gyeonggi-do

Korean Webpage

Kakao Yellow ID