※We will reply to your inquiries in one way shape or form on the day the inquiry is made, if the inquiry is within the operation time.
※If there is no reply after one business day, there is a possibility that we have no recieved your inqurie., if so please contact us by phone. (TEL: +66 (0) 2-107-1039

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

Consultation place(Required)

Consultation History(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.)

How to Get a Confirmation

You can choose both.

Contents of consultation(Required)

※You can choose two or more.


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