Inquiry Forms

Please select the corresponding inquiry form from below and go to the input screen. Please note that we cannot accept the inquires by telephone or E-mails. Personal identifiable information will only be used for answering your inquiry. We will respond to you within 5 business days.

Inquiry for Medical Treatments

Inquiry Form

If you are considering receiving medical treatments at Aizawa Hospital, a referral letter from your physician is required. Please fill in our online inquiry form and upload the referral letter.

Inquiry for Medical Practitioner

Inquiry Form

If you are considering receiving the clinical training at Aizawa Hospital, please fill in our online inquiry form.