Optional Examinations
Change / Add Request Form
- This form is only for those who have made an appointment (date of consultation) in advance.
- Reservations are not confirmed only by submitting this form. We will usually reply to you within 3 business days. In the unlikely event that you do not receive a reply from us after 3 business days, please contact us by phone.
Our clinic will be closed for the Golden Week holidays from Wednesday, April 29, 2026, to Wednesday, May 6, 2026.
Inquiries received during this period will be handled sequentially from Thursday, May 7, 2026.
We appreciate your understanding and patience.
Registration Form
*Please fill out the registration form below.
If the form does not appear, please wait a moment or wait some time before accessing it again.
*All prices include tax.
About Security
The contents of your inquiry will be encrypted by SSL encryption technology.
Please be assured that your important information will not be exposed to a third party.