公益財団法人田附興風会 医学研究所北野病院

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Usage Guide

Request to change medical appointment

Usage Guide

User Guide

    Request to change medical appointment

    ◎Please be sure to check this first.

    • Reservations cannot be cancelled using this form.Please contact the outpatient block reception.
    • The reservation dateReservations cannot be changed within one week.Please contact the outpatient block reception.
    • If you want to change your reservation,In principle, changes must be made to the same doctor and the same day of the week.It will be.
    • It may not be possible to change your appointment depending on the doctor's judgment, the reservation situation, and the type of test.
    • If you postpone your appointment, please check whether you have enough prescription medication. If you do not have enough, please contact the outpatient block reception.
    • Reservations cannot be changed for non-medical appointments such as prenatal checkups, vaccinations, and surgeries. Please contact the outpatient block reception.

    ◎Application for reservation change
    Please prepare your medical card and appointment slip and answer the following questions.

    Patient numberRequired

    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 addressRequired

    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

    Mobile phone number (no hyphen)

    Home (no hyphen)

    The type of reservation you want to change
    Medical appointmentRequired

    [Current] Reservation date and time (cannot be changed within one week):

    Reservation time:

    [Current] Reservations with:

    [After change] Desired date and time:
    *If you do not select "Any time", please press the date section and enter up to your third choice.
    *As a general rule, doctors cannot be changed.
    　
    (1)

    (2)

    (3)

     

    Add clinical department
    Medical appointment 1

    [Current] Reservation date and time (cannot be changed within one week):

    Reservation time:

    [Current] Reservations with:

    [After change] Desired date and time:
    *If you do not choose "Any time", please enter up to your third choice.
    *As a general rule, doctors cannot be changed.
    　
    (1)

    (2)

    (3)

     

    Add clinical department
    Medical appointment 2

    [Current] Reservation date and time (cannot be changed within one week):

    Reservation time:

    [Current] Reservations with:

    [After change] Desired date and time:
    *If you do not choose "Any time", please enter up to your third choice.
    *As a general rule, doctors cannot be changed.
    　
    (1)

    (2)

    (3)

     

    Add clinical department
    Medical appointment 3

    [Current] Reservation date and time (cannot be changed within one week):

    Reservation time:

    [Current] Reservations with:

    [After change] Desired date and time:
    *If you do not choose "Any time", please enter up to your third choice.
    *As a general rule, doctors cannot be changed.
    　
    (1)

    (2)

    (3)

     

    Is there an appointment for testing on the day of the consultation?Required

    *Test reservations for first-time patients are only accepted through the referring medical institution, so test reservations cannot be changed using this form. Please select "First-time appointment" and consult with the referring medical institution to change the test date.

    *Depending on the test, it may not be possible to change the date.

    　

    Remaining medication until the desired appointment change dateRequired

    Other (information that cannot be entered in the form above, etc.)

    Even if your application is complete, the reservation change is not complete.We will contact you again by email or phone at a later date.

    If you do not receive any contact for more than two days, please contact the appointment change desk at 06-6312-8848 or the outpatient block reception desk.

     

    Information