WEB Counseling Reservation

The first counseling is free of charge. Please feel free to consult with us.

【All items require entries】Please answer all items.

Content of Consultation    
Preferred dates
1st preferred date Day Month Time
2nd preferred date Day Month Time
3rd preferred date Day Month Time
Name
Relationship with the patient   
Email address
Email address
(Please enter again.)
Telephone Number

*We'll call you for confirming your reservation. So, if possible, inform us your mobile number Otherwise, inform us your home telephone number.

address
post code 〒

prefecture

Address
Sex  
Type of cancer
Stomach cancer
Esophageal cancer
Colon or rectal cancer
Liver cancer
Bile duct cancer
Pancreatic cancer
Thyroid cancer
Lung cancer
Breast cancer
Kidney cancer
Prostate cancer
Head and neck cancer
Brain cancer
Uterus cancer
Ovary cancer
Others
Metastases  
Plans for surgical intervention   
How did you know about our hospital
Magazines
Newspaper
By word of mouth
Orientation
Internet
Doctor
Others
Others Please feel free to write your requests or questions.

 

 

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Shonan Medical Clinic Immunotherapy Free dial:0120-798-300 AM10:00~PM7:00

 

 

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