Contact UsContact Us LINE
  • form
  • confirm
  • thanks
※Name
※Address
※Telephone Number 例09012345678
※Email Address 例example@example.com
※Age
Do you have any chronic illness?
The name of illness :
Are you taking any medicine?
The name of medicine :
Do you have any allergies?
Allergy object :
What are your symptoms?
Please let us know a number of preferred days that you would like to have first medical examination.

The first choice

The second choice

The third choice
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