Request appointment

Full name Required

E-mail Required

Date of Birth Required

Nationality Required

Gender Required

MaleFemale

Current Address Required

Duration of Stay in Japan and City Required

How did you find Okuno Clinic.? Required

---InternetReferral from family or friendsReferral from a physicianSocial networking services (Facebook, X, Instragram, Youtube, etc.)Other sources

Do you speak Japanese? Required

YESNO

If No above, is it possible for you to be accompanied by an interpreter?

YESNO

Subject Required

---Request an appointment for the first timeCancel or change my appointmentRequest an observation **PHYSICIAN ONLYRefer a patient **PHYSICIAN ONLY

Inquiry Required

Please describe your symptoms, such as when the pain or discomfort started, any medication or treatment you have taken, etc.