Make an Appointment via Web

●By Phone

*Please make sure to call us if you wish to make an appointment on that day.

●Make an Appointment on the Web

STEP.1 Fill out the request form and send.
STEP.2 We will confirm your appointment based on your request.
STEP.3 Please check the date and time and reply to the e-mail. Your e-mail will be the final confirmation of your appointment. (If you prefer confirmation by phone, no need for sending an e-mail.)


Consultation place(Required)

Consultation History(Required)

Name(Required)

Please type in alphabet. e.g.) Tanaka Taro

Date of Birth(Required)

/ / (yyyy/mm/dd)

Phone Number(Required)

Please type using half-width characters. e.g.)021071039

E-mail address(Required)

Please type using half-charatcers e.g.)123@dyminternational.com

How to Get a Confirmation

You can choose both.

Contents of consultation(Required)

※You can choose two or more.

Note

Please write your symptoms and when it appeared in detail. Please write what you are allergic to if any.