To persons who hope to be examined
This clinic sees patients only by appointment.
You are required to fill in and submit the following application form to make an appointment. Moreover, please read the following notes before your appointment.
- To prevent of the spread of COVID-19, please refrain from coming to seeing a doctor or examination within two weeks if you had any possible symptoms such as fever (including after vaccination), cough or fatigue and you had close contact with a COVID-19 patient.
- We will use the information you provide in this application form only to contact you to fix your appointment.
- It is not possible to make an appointment within the next three days using this application form. In case you need an appointment within the next three days, please call us directly on our toll-free number: 0120-17-4455(9:30 - 18:00). (Appointments can be made for the next two months.)
- Your appointment will be fixed only when a member of our clinic staff contacts you to confirm it by telephone or email. Please note that your appointment date is not confirmed when you submit this form.
- Please note that your preferred appointment date may be unavailable.
- Since we prepare our schedule in advance, appointments will only be available for a date four days hence.
Notes for the examination
- The examination and consultation will last approximately two and a half hours.
- You will have blurred vision and feel slightly dizzy for approximately three hours after the ophthalmoscopy. Therefore, please do not travel to the clinic by car.
- Your clinic is closed every Sunday and Tuesday.