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Change of Counselor Form

Instructions: Use this form to request a change in counselor. Our Intake Specialist will contact you within 1–3 business days to discuss next steps.

Client's Name

*

Client's Phone Number

Client's Email Address

*

Current Counselor's Name?

Client's reason to request new Counselor:

Not satisfied with Counselor's competence level

Counselor's style is too unstructured and passive

Counselor's style is too direct

Counselor initiated (ex: Counselor leaving country, etc)

Scheduling challenges

Other

Counseling goals you'd like to focus on with new Counselor:

Preferred Counselor’s Background:

(select all that apply)

Preferred Counselor’s Background:

Male counselor

Female counselor

Christian-based counselor

Non-religious counselor

LGBTQ+ counselor

Counselor of color

English-speaking counselor

Korean-speaking counselor

Bilingual (En/Ko) counselor

Interns/Resident Counselor

MA-Level Licensed Counselor

PhD-Level Licensed Psychologist

No Counselor Preference

Other

Your desired center location is:

Seoul Center

Pyeongtaek Center

Online

What Dates/Times are you available for regular sessions with your new counselor?

Example: Wed 7pm~9pm (online), Sat 10am~12pm (in-person)

Counseling Style Preferences (Optional)

Would you like to complete 10 more items to further personalize your counseling experience?

Counseling Style Preferences (Optional)

A

Yes

B

No

Change of Counselor Form

Client's Name

Client's Phone Number

Client's Email Address

Current Counselor's Name?

Client's reason to request new Counselor:

Counseling goals you'd like to focus on with new Counselor:

Preferred Counselor’s Background:

Your desired center location is:

What Dates/Times are you available for regular sessions with your new counselor?

Counseling Style Preferences (Optional)

Any other comments or requests, including any specific counselor(s) you'd like to meet?