Reservation | がん検診・内視鏡検査のスペシャリスト Takahiro Fujii Clinic

If you would like to have an examination at our clinic, please fill in the form below. We will arrange an appointment for a pre-examination consultation.
Alternatively, please feel free to contact us by telephone at our clinic.
* Please note that this clinic is self-funded medical treatment.

Gastroendoscopy	Colonoscopy	colonoscopy with day-surgery
100,000 yen～	120,000 yen～	220,000 yen～

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
09:30〜12:00							
13:00〜17:00							

Reception telephone number （by appointment only）

TEL.+81-3-3544-6266

Reservation process

Please fill in the following booking form.
As soon as we have confirmed the details you have entered in the booking form, the clinic will contact you by e-mail or telephone to confirm your booking.
When the date and time of the consultation or examination has been decided, please read the instructions before coming to the clinic.

Reservation form

Please make an appointment prior to visit.

Patient Name[Required]

Nationality [Required]

Cell phone number[Required]

Mail address[Required]

Gender

Male Female

Date of Birth/Age

Preferred Medical Treatment[Required]

Gastro Endoscopy Colon Endoscopy Gastro & Colon Endoscopy Outpatient Consultations Other

Number of Consultations[Required]

First time Second visit or later

* Please note that this clinic is self-funded medical treatment.

At the clinic, you will be asked to fill out a medical questionnaire when you come in for your endoscopy appointment.
If you download this form and bring it with you, you do not need to fill it out at the clinic. If you fill out this form and bring it with you, you do not need to fill it out at the clinic.