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

---Less than 1 weekLess than 1 monthLess than 1 yearOver one yearPermanent residence

What city are you currently in? 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

Our clinic primarily conducts consultations in Japanese.
If you are able to receive both medical consultation and treatment in Japanese, please check the corresponding box below.
If you do not speak Japanese and will be accompanied by a Japanese interpreter, or if you prefer to have the consultation in English, please check the appropriate option. Required

※Please check one of the following required options:
I am comfortable with a consultation in Japanese.I will have a Japanese interpreter accompany me for the consultation.I would like to have the consultation in English.

Who will be acting as the interpreter?

---My family, relative, or partnerMy acquaintanceA professional interpreterColleague, secretary or assistant

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.