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.