Reservation form

Please select your desired date and time.

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Clinic dates and times:
Saturday, Sunday, Monday, Tuesday, Wednesday
from 9:00 a.m. to 4:00 p.m.
To change or cancel your reservation, please contact us by phone or email.

Reservation by phone

090-6921-7696

（If available, you can make a reservation on the same day.）
*Basically, you will be treated at our clinic, but if it is difficult to visit me, I will make a house call to your home.

Reservation by email

hiroshitmidori@gmail.com

Please fill out the following information and send us an email.

Name
Date and time (please write your second choice)
Other requests and questions

（Reservations must be made by the day before.）