Get Free Consultations Patient First Name Patient Middle Name Patient Last Name Nationality Date of Birth Age Body Height (cm) Patient's Body Weight (kg) Email Address Phone Number WhatsApp Number Address Gender MaleFemale Diagnosis ObtainedNot obtained Do you have an accompanying person? Yes, I have an accompanying personNot yet decided Allergy History I do not have an allergyI have an allergy Walking Be able to walk unassistedNeed Help Sitting posture Be able to maintain a sitting positionNeed Help Eating and drinking Be able to eat and drink unassistedNeed Help Going to lavatory Be able to go to the lavatory unassistedNeed Help Medical institution you wish to seek medical attention I have no preferenceI have a preference Preferred date of medical consultation I have a preferenceI have no preference Do you have a medical institution where contact and arrangements have already been made? yesno Passport i have passportWill be getting my passportI do not have my passport Purpose of Your Inquiries ExaminationTreatmentTo obtain guarantee from a guarantor when applying Medical Stay Visa How did you know our website? google searchfacebookinstagramheard from somone Doctors appointments or any other services call us to following number 24/7. +81 80-6588-7619
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