Contact us (please complete the form below)

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  2. Contact us (please complete the form below)

Contact us ( please complete the form below )

Depending on the content of your inquiry, you may not be able to answer. Please forgive in advance. In addition, it may take several days for your reply.
Please fill in the following details and click “Send” button.
Please note that this is not a reservation form.
The reservation center number is 047-351-3230.

Patient ID (If you have)

Date of birth (YYYY/MM/DD) (required)

Your Age (required)

male or female (required)

Zip code

Your address (required)

Your telephone number (required)

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