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Reservation Form


Requests for consultation of minors (mainly under 18 years old)

・As a cardiology clinic specializing in the heart, we recommend that you visit the clinic when you are about the age of a high school student. (For physical and health consultations and medical examinations during the growing season, it is best to consult a pediatrician or your usual doctor.)

・As a general rule, parent(s) are required to accompany high school students. If it is unavoidable to accompany your parent(s),

 1. Ask the parent if he / she knows to go to the clinic,  2. If the parent does not know, he / she may refrain from medical treatment,  3. After medical treatment, please report to your parent(s),  4. Parents need to be contacted for important decisions.

We apologize for any inconvenience, but we appreciate your understanding and cooperation in order to provide safe and secure medical care.



  • (初めてご受診:Initial consultation)

  • (ご受診歴あり:Follow-up visit)

  • 注意: 新型コロナウイルス感染症特例措置。医師の判断により、オンライン診療が難しい場合もございます。予めご了承ください。

    ①事前に手数料払 ②診察後に診療費お会計
About Telemedicine

 Online  diagnosis/treatment are available only for repeat visit patients.

In online medical treatment , you can see a doctor using a communication device.

However, because the information that doctors can obtain is limited due to the inability to palpate, there is a risk that medical examination will be more difficult than face-to-face medical examination.

Please note that we may ask you to visit us if it is difficult for you to make a diagnosis or prescribe by Telemedicine at the doctor's discretion.


*If you are a first time visitor, please contact us.

*Please note that we may not be able to meet your request.

If you will send the above reservation inquiry form、we will be respond after confirmation.
Please dont use carrier email address such as docomo, au (ezweb), SoftBank, etc.
If you are in a hurry or booking same-day treatment, please call us.

1. Online connection from our hospital

When the appointment time is approaching, please wait for the call at the place where you can see the doctor.

The clinic staff will contact you to verify your identity first. After that, you will be examined by a doctor. (Calls may be delayed due to congestion)


If you are using online medical care on your smartphone, it will be smooth if you register in advance using the "Google Meet" (Android) and "Hangouts Meet by Google" (iPhone) apps.

If you are using it on a PC, click the URL link that you will receive.

 Flow of Telemedicine

2.Confirmation of health insurance card, medical certificate, etc.

The clinic staff will confirm it and kindly ask for preparing health insurance card and medical certificate.

3.Confirmation of payment method

We will confirm the payment method.

Please use the following services for payment.

Payment services: Credit card, PayPay, LINE Pay, bank transfer

* Please pay by any of the above methods within the day after the medical examination.

After asking for your preferred payment method, we will send you a payment form to your registered email address.

4.Medical treatment

We will be required to provide telemedicine  care with your doctor.

5. Prescription

If you have a prescription after medical treatment, we will fax the prescription to the pharmacy of your choice, so please receive your medicine.

* Please contact the pharmacy for how to receive it.

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