International Health Care Clinic

International Health Care Clinic

Frist Consultation

Frist Consultation

Name ※
Sex ※
Date of birth
Request of appointment, Date and Time
Close:(Mon)・Sat・Sun・National Holidays
In case of emergency, we will hear even on leave day so please contact us directly by phone.
First:
Second:
Tird:
Purpose of visiting
Email※
Remark

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