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ViaJiin - Early Access Intake
We are currently only focusing on Seoul Clinics
About You
Full Name
*
Country of Residence
*
Are you 18 and above
*
We are only accepting clients 18 and above
Are you 18 and above
Yes
No
Email Address
*
Do you have another preferred communication method? (whatsapp/IG) If so, please share your ID/handle
Travel Information
Are you planning to visit Korea?
*
Are you planning to visit Korea?
A
Already in Korea
B
~Within 1 month
C
1-3 months
D
Just researching
Is there anything specific you’d like clinics to know about your goals or concerns?
Treatment Goals
What types of treatments are you interested in learning more about?
*
What types of treatments are you interested in learning more about?
Do you have specific procedures in mind? (optional)
Areas of Concern or Interest - Please describe
*
Have you had aesthetic treatments before
*
Have you had aesthetic treatments before
Yes
No
Budget & Priorities
Estimated budget range (USD)
*
Estimated budget range (USD)
A
Under $500
B
$500 - $1,000
C
$1,000 - $2,000
D
$2,000 +
E
Not sure
What matters most to you? (multi-select)
*
What matters most to you? (multi-select)
I consent to ViaJiin sharing my submitted information with partner clinics solely for appointment evaluation and treatment safety.
*
I consent to ViaJiin sharing my submitted information with partner clinics solely for appointment evaluation and treatment safety.
Yes
I understand ViaJiin provides matching and introductions, and that final medical decisions are made between me and the clinic.
*
I understand ViaJiin provides matching and introductions, and that final medical decisions are made between me and the clinic.
Yes
I consent to being contacted regarding clinic recommendations related to my request.
*
I consent to being contacted regarding clinic recommendations related to my request.
Yes
Submit
