Please make your reservation at least 3 days in advance, if possible.

Please note that submitting a reservation request through this website does not guarantee your appointment. The confirmed date and time of your reservation will be communicated to you by our hospital staff.

Additionally, same-day reservations cannot be made via email. If you wish to schedule an appointment for the same day, please contact us directly by phone.

NameRequired
Date of Birth
Patient ID Number
Phone NumberRequired
(Phone number reachable during daytime)
Email addressRequired
Email address (confirmation)Required
Preferred date - 1st choiceRequired
Preferred date - 2nd choice
Preferred date - 3nd choice
Symptoms, etc.Required
※Example Symptoms: Lower back pain, neck pain, numbness in the right hand, etc.
How You Learned About Our Hospital必須

If 'Other' is selected