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Online visit application form

* Required

* Since it takes time to make adjustments, please select a date that is at least 3 days ahead of the application date.

Reservations are on a first-come, first-served basis. Please note that we will not be able to accept reservations made by other customers at the same office during the same time period.

​ In addition, please note that we may not be able to meet your request due to other business reasons.

We may not be able to meet your request regarding the date and time of your reservation.Thank you for your understanding.

For online visits, we will use the meeting tool "ZOOM". To use it, you need the latest "ZOOM Cloud Meetings" app.

* Account registration is not required.

In addition, the customer is responsible for the communication charges when installing the app and during the visit.


Click here for IOS version installation

Click here for Android version installation 


It may take some time to answer. If you are in a hurry, please contact us by phone.

TEL: 0766-86-8857


■ Purpose of use

The personal information you enter will be managed based on our Privacy Policy, and will be used only for responding to and responding to inquiries and inquiries.

■ To those who submit the form

Please be sure to read the above "Purpose of use" and " Privacy Policy r ", and if you agree, check "I agree" and click the "Send" button.

Transmission completed


At the same time as sending your inquiry / request, we will send you an email notifying you that the reception has been completed.


If you do not receive the email, the email address you entered may be incorrect.

Sorry for your inconvenience, but please enter the correct email address and contact us again.

Copyright © MEDICAL CARE CO., LTD.

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