Inquiry form

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In the following form, please input and transmit your information and inquiry.

* is the mark for required item.

First Name: Last Name:
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For basic policy on the protection of personal information

*For us of the protection of personal information about the basic policy, and please confirm from here.

The use of personal information is in our hospital, the following will carefully read the contents, on your note, so that you will apply the inquiry, thank you.

Please send upon check in Please confirm "agree" the basic policy regarding the protection of personal information.