UNIST Healthcare Center Application(Short form)

Welcome to the UNIST Healthcare Center!
Please Fill out the questionnaire to apply for counseling and clinic treatment
If you do not hear from us within 2 days(not including weekends and holidays), contact us at 052)217-4018.

[Procedure for counseling and clinic treatment]
① Apply via online(Google) or in-person visit.
② Individual contact
③ Submit a formal application and conduct a intake counseling in the Healthcare Center
④ Matching with a counselor
⑤ Counseling(once a week, 10 sessions) / Affiliated clinic treatment (suspended due to the absence of treatment staff; referral to external clinic only) 
⑥ Completion(external referral in some cases)
 
[Notice] The questionnaire below asks for minimum information to facilitate the application.

[Consent to Collection and Use of Personal Information]
The Healthcare Center intends to collect and use personal information as follows to provide mental health services. Please read the contents carefully and decide whether to agree or not.
- Collection items: desired service, name, affiliation, phone number
- Purpose of collection: Personal identification for applying for mental health services, scheduling appointments, etc.
- Retention period: 5 years
- Basis: Medical Act Enforcement Decree Article 42-2 (Processing of Sensitive Information and Unique Identification Information), Medical Act Enforcement Regulations Article 15 (Preservation of Medical Records, etc.)

You have the right to refuse to consent to the collection and use of personal information above. However, if you refuse to consent, you will incur disadvantages such as not being able to apply for services.

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​Do you agree to the collection and use of personal information? *
1. Which service do you want?* *
2. What is your affiliation?
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3. What is your full name?  *
4. Please enter an accurate phone number where you can be reached. *
5. Please enter the date and time you are available in the near future.
6. Leave a comment if you have anything to say.
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