公益財団法人田附興風会 医学研究所北野病院

inquiry
search close
MENU

Departments

Cancer consultation reservation form

Departments

Medical Departments

    About the Cancer Consultation Support Center Reservation Form

    Our hospital does not accept cancer consultations via email. Please understand that we will not be able to respond to any inquiries you may have in an email.

    After you contact us by email, our staff will contact you to arrange a time for you to visit us.

    Handling of personal information

    Any personal information obtained through inquiries will be handled appropriately in accordance with our privacy policy.

    Inquiries via email form

    Please enter the following information and press the send button.
    RequiredFields marked with are required.

    Inquiry details
    Name

    Last name:

    given name:

    *Please provide only your last name, or any other name that can be confirmed when we contact you.

    Furigana

    Sei:

    Mei:

    Kitano Hospital medical history

    If you have visited Kitano Hospital before, please select "Yes."

    Patient number

    -

    -

    Email (half-width)Required

    telephone numberRequired

    -

    -

    Disease name

    Consultation detailsRequired

    *If your email address or phone number is incorrect, our staff will not be able to contact you. Please be sure to check.

    This site is protected by reCAPTCHA and the Google
    Privacy Policy and Terms of Service apply.

    Information