Survey for Consultation

1. Personal Information

Name

First Name

This field is required.

Last Name

This field is required.

Nationality

This field is required.

Place of Birth

Place where you were born (city or county, state or country)

e.g., San Diego, California / Tokyo, Japan

This field is required.

Place of Residence

Place where you reside (city or county / state or country)

e.g., San Diego, California / Tokyo, Japan

This field is required.

Sex

Male

Female

Preferred Language

English

Korean

Marital Status

Single

Married

Remarried

Separated

Divorced

Widowed

Contact Info

This field is required.

Mobile Phone (Optional)

This field is required.

2. Birth Information

Your Birth

<NOTE>
- Your birth information is required in all cases.
- If you are single, please provide your mother's birth information or that of both your parents.
- If you are married, please provide your spouse's birth information.
- If you are remarried, please provide the birth information of both your current spouse and ex-spouse. (Your ex-spouse's birth information is essential.)
- If you have someone in mind and want to know if he/she is a good match for you, please provide his/her birth information.

Information of Your Birth

Date of Your Birth

date month, year (e.g., 12 Oct. 2001)

This field is required.

Time of Your Birth (e.g., 16:30)

presumed time when you don't know exactly

This field is required.

Birth Information of the Person Connected to You

Relationship with you

e.g., wife, husband, mother, male/female partner, . . .

This field is required.

Date of Birth

date month, year (e.g., 12 Oct. 2001)

This field is required.

Time of Birth (e.g., 16:30)

presumed time when you don't know exactly

This field is required.

Birth Information of the Person Connected to You

Relationship with you

e.g., wife, husband, mother, male/female partner, . . .

This field is required.

Date of Birth

date month, year (e.g., 12 Oct. 2001)

This field is required.

Time of Birth (e.g., 16:30)

presumed time when you don't know exactly

This field is required.

Birth Information of the Person Connected to You

Relationship with you

e.g., wife, husband, mother, male/female partner, . . .

This field is required.

Date of Birth

date month, year (e.g., 12 Oct. 2001)

This field is required.

Time of Birth (e.g., 16:30)

presumed time when you don't know exactly

This field is required.

3. Your Top Concerns

Please briefly state what you want to know most. Providing detailed descriptions of your situation will help in receiving clearer advice.

<Notice>

1. We will send you a reminder notice about your reservation one day before the meeting.
2. We will invite you to the online meeting room 10 minutes before the scheduled start time.
3. If you have any questions, please use the contact form under the "CONTACT" menu on our homepage (https://mme-sujin.com).