Temporary Dialysis for Travelers inquiries

We accept inquiries about temporary dialysis for travelers.
Please let us know your preferred date and time for the dialysis, and whether or not you have a referral letter.
Please note: Items marked with「※必須」are required to complete the form.
We will contact you by email after reviewing your request.
Please allow some time for confirmation.
Inquiries received on weekends or national holidays will be answered on the next business day.

Entry Form

Your Name(Required)※必須
Furigana(Japanese phonetic name)
Address
 
Phone Number(Required)※必須
Email Address(Required)※必須


Inquiry Category(Required)※必須
Inquiry Details(Required)※必須