公益財団法人田附興風会 医学研究所北野病院

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Visitor Guide

Cancellation of a follow-up appointment

Visitor Guide

User Guide

    Cancellation of follow-up appointment

    ◎Please be sure to check beforehand
    please

    To change your appointment at the Chemotherapy Center, Radiation Therapy Center, Palliative Care Department, Neuropsychiatry Department, or Dentistry and Oral Surgery Department, please call the office indicated directly.

    • Cancellations cannot be made by phone or email.Please note that if you wish to reschedule your appointment, you will need to come in to see us.
    • If more than six months have passed since your last visit, you may need a referral letter from another medical institution.
    • If a doctor's confirmation is required before cancelling, our staff may contact you.
    • Cancellations of initial consultation appointments cannot be made using this form.This pagePlease refer to the reservation change procedure.
    • Changes to follow-up appointmentsThis special formWe accept applications at.

    Cancellation application form for follow-up appointment

    Please enter the following information and press the send button.RequiredItems marked with an asterisk are required.

    Patient number (8 digits starting with 0)Required
    Patient nameRequired

    Last name　

    given name

    Patient name (full-width katakana)Required

    Sei　

    Mei

    Date of birth (half-width characters)Required

    (Gregorian calendar)year

    month

    day

    Email address (half-width)Required

    Please set the domain to "kitano-hp.or.jp" so that you can receive emails from Kitano Hospital.
    Also, please note that email addresses created with docomo and au before around March 2009 may not be able to receive emails.

    telephone numberRequired

    cell phone -

    -

    one's home -

    -

    Medical appointment ①Required

    Reservation date:

    　

    Reservation time:

    Reservation department:

    Medical appointment ②

    Reservation date:

    　

    Reservation time:

    Reservation department:

    Medical appointment ③

    Reservation date:

    　

    Reservation time:

    Reservation department:

    Medical appointment ④

    Reservation date:

    　

    Reservation time:

    Reservation department:

    Make an appointment for testing on the day of your appointmentRequired
    others:
    remarks

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    Information

    Cancellations cannot be made by phone or email.

    Please note that if you wish to reschedule your appointment, you will need to come in to see us.

    please

    To change your appointment at the Chemotherapy Center, Radiation Therapy Center, Palliative Care Department, Neuropsychiatry Department, or Dentistry and Oral Surgery Department, please call the office indicated directly.

    • If more than six months have passed since your last visit, you may need a referral letter from another medical institution.
    • If a doctor's confirmation is required before cancelling, our staff may contact you.
    • Cancellations of initial consultation appointments cannot be made using this form.This pagePlease refer to the reservation change procedure.
    • Changes to follow-up appointmentsThis special formWe accept applications at.

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