Child Therapy & Parenting Support

First Name

Last Name

Address in Korea

Cellular Phone Number

Gender

Male

Female

Others

E-mail

Birthday

Nationality

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

I prefer to schedule an appointment during ___ of the day. Please choose all available hours.

Morning (10am-12pm)

Afternoon (1pm-4pm)

Evening (5pm-8pm)

I prefer to see ______ level of therapist. The fee may vary depending on the language, duration of session, and age(minor).

Ph.D. Licensed Psychologist (200,000KRW-320,000KRW)

Master's Counselor (150,000KRW-300,000KRW)

Resident (80,000KRW-150,000KRW)

[Currently Unavailable] Intern (50,000KRW-100,000KRW)

I have received therapy in the past.

Yes

No

Not Sure

If you have international insurance, do you plan to use it or submit a claim for your sessions?

If you plan to use international insurance, please write the name of your policy in this field and upload the front and back of your insurance card in the fields below.

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

Upload file

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 a penalty fee for the missed appointment.

I hereby acknowledged that I read the YPCS's 24-hour cancellation policy.

Submit

Schedule Appointment at Seoul Office

Intake Process

Step 1
Complete the
Application Form

Click the "Schedule Appointment" button and fill out the application form based on the service you are seeking.

Step 2

Contact From Our Intake Coordinator

Our intake coordinator will contact you via phone or email within 3-5 business days to arrange your first therapy appointment.

Step 3

Begin Counseling

Complete the intake forms before the first session. Meet your therapist and begin the counseling process.

Registration Form (Parenting/Underage Child Therapy)

You&Me Psychological and Counseling Services (YPCS)

HOURS

BANK ACCOUNT

ADDRESS

CONTACT US