Contact Form

Please fill in the form below, check that all of the information you have entered is correct, and then click the "Confirm Entered Information" button to submit.
Please refrain from asking individual questions about doctors or staff.
Please also note that we cannot respond to any inquiries regarding individual treatments.
Depending on the nature of your inquiry, it may take some time to respond.

Enter
Content confirmation
Complete

Name ※Required	Surname(Family Name）
Name ※Required	Name(First Name）
Email address ※Required
Confirm email address ※Required	* We are unable to accept email addresses from some domains, such as Yahoo.com. If you do not receive an email confirming receipt, please use another email address.
Subject of inquiry ※Required
Content of inquiry ※Required
Age (optional)
Sex	Male Female
Institution (for corporations)

If you agree with our hospital and privacy policy, please check "I agree" and click on the "Confirm Entered Information" button.

I agree

A response from the project will be sent to the individual who made the inquiry. Please refrain from reprinting or reusing this form in whole or in part.