contactContact

Contact

Contact

As a rule, our clinic will contact you during clinic hours.
It may take some time for us to reply to your inquiry. Please understand this in advance.

  1. 1
    Input
  2. 2
    Confirm
  3. 3
    Complete
Contact person’s name
Relationship to patient
Phone Number
E-mail
Patient’s name
Patient’s area of residence
Inquiry Type

Please fill in the following if ‘Other’ is selected.

Inquiry details

※ Please provide details such as the name of the disease, cancer stage classification, medical history, age, and gender.

※ The registered information will be strictly managed in accordance with our privacy policy.
※ Online consultation is available for a fee.
※ Those who come to Japan from overseas and wish to receive treatment must have a medical coordinator. We will introduce you to a medical coordinator.

How did you find our clinic?
referral（who referred you to our clinic?）

Internet

search sites for hospitals

name of the sites

our website(How did you find our website?）

Yahoo!, Google and others

search engines

search keywords

others（specifically）
magazines（name of the magazines）
others（specifically）
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