Fill in the following items and please click confirm
* it is required field
Name*
Residential situation
ResidentTourist
How long you will stay in japan?
Phone number（*e.g. 0120005327）
Mail address*
*If you have set the rejection of reception by specifying a domain.In that case Please set the setting, Please set “azabuskinclinic.info@gmail.com as domain boarding reception
Contact method of return*
PhoneMailEither is acceptable
*when confirming your resarvation,please cheeck the return method
*If you can not contact us by email ,we will call you
Reservation desired date
Our clinic is closed on Mondays and Tuesdays.
First choice
Select time10:00〜12:0012:00〜13:3015:00〜17:0017:00〜19:30anytime
2nd choice
*If you make a reservation and in a hurry. Please call us within 3 days
*Depending on the condition of medical treatment on the day, there maybe cases where the medical treatment time will be delay on the time of reservation. It is highly likely that you will have to wait especially on Saturdays. We will make every effort to provide medical treatment and treatment at the time you make a reservation, but please note that it may past the reservation time.
Gender*
選択してくださいFemaleMaleOther
Age
選択してくださいbelow1920-2425-2930-3435-3940-4445-4950-5455-59above 60
Nationality
Desired treatment*
選択してくださいPigmented SpotsAcne, Acne ScarsScarringHormoneLaser Hair RemovalMedical Skin IssuesWrinklesSaggingSagging (Thema)Sagging (Doublo)Other
Free Entry Field
