Reservation

〜attention〜

A lot of those who set the mail communication blocking are seen, and not being possible to reply from the this hospital even if the mail reserved from you with great pains is received is a current state recently.

Sorry to trouble you, but I will transmit after permitting domain chuoh-clinic.co.jp or releasing the communication blocking setting.

Please refer to HERE for the domain release.

free dial
0120077645

Please input a necessary matter.
※ an input indispensability item.

※Name

※Family Name


※e-mail

※Address

※Age
age

※ Telephone Number


Emergency Contact


How is the reporting method from us?
Telephone
e-mail

Report hope time zone


性別： Male Female

Reservation hope date:
I will limit the reservation on the Internet three days from today after as the desired date from now on.
It receives it by the telephone for the desired date within three days.


The first hope day ※:
month day
9:30〜12:00
12:00〜18:00
18:00〜20:00

The second hope day :
month day
9:30〜12:00
12:00〜18:00
18:00〜20:00

The third hope day :
month day
9:30〜12:00
12:00〜18:00
18:00〜20:00

Please select the consulted content.
Dissatisfaction with eyes and eyelids
Dissatisfaction with nose
Dissatisfaction with mouth and ears
Dissatisfaction with face such as facial line
Rejuvination
Dissatisfaction with breasts
Diet and fat removal
Body odor and sweat
Dissatisfaction with genitals
Hair removal
Others(navel and body, etc.)

Content of consultation(Please write in as much detail as possible. )


How is the payment method done?
Diners,AMEX,VISA,Master,Million,JCB,UC,DC)
Cash
Credit card
Medical treatment loan

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