Form cover
Page 1 of 3

Document Request Form

Welcome to Seoul Counseling Center’s Document Request Form.

Clients or legal guardians may use this form to request documents related to services received at the Center.

Please note:
- Request Review: All requests are reviewed according to Center policies, clinical appropriateness, and whether the requested document can be provided.
- Payment: Payment is required before document delivery or pick-up.
- Processing Time: Most requests are completed within 5–10 business days, depending on the document and circumstances.
- Insurance: Document fees are not covered by insurance and must be paid out of pocket.
- Multiple Requests: Please submit a separate form for each document type.
- Delivery: Documents will be sent through the Healthie Secure Messaging Portal. Please ensure your account is set up using the same email address you used when registering for services. If you need help accessing your account, contact our Front Desk for a password reset.

Thank you for your cooperation.

Client's First Name

Client's Last Name

Client's Date of Birth (Month & Day)

Example: November 24 (Used to distinguish clients with the same name)

Client's Registered Center

A
B
C

Counselor Name

Please enter the name of the counselor you are requesting a document from.
(If you don't know the name of your counselor, please visit our Website, or contact our Front Desk