International Health Care Clinic

International Health Care Clinic

Follow up Consultation

Follow up Consultation

Name ※
Sex ※
No. of your card
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