We accept
Japanese Health Insurance
.
CT scans
are available for an accurate diagnosis.
Services & Price
Our Staff
Technology
Blog
Offices
日本語
Make Appointment
Services & Price
Our Staff
Technology
Blog
Offices
日本語
Make Appointment
Akasaka Office
You can request an appointment by phone or using the online form below.
Schedule
Monday - Saturday
10:00–19:00
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Closed on Sunday & National Holidays.
Appointments by request outside of normal business hours.
This form is for appointment requests. Please wait for our contact to confirm your appointment.
Appointment by Phone
ENGLISH
03-6277-7983
JAPANESE
03-6277-7981
Online Form
Name
*
Email
*
Phone
*
Preferred Date
*
MM slash DD slash YYYY
Preferred Time
*
:
Hours
Minutes
Is it an emergency?
*
Yes
No
Do you have Japanese health insurance?
*
Yes
No
Important Notice
About Insurance Verification and Deposit
To ensure smooth and accurate billing, our clinic requires a refundable
¥20,000 cash deposit
for patients whose
National Health Insurance (NHI) card or My Number card cannot be verified at the time of the visit.
This applies to:
Patients
without a valid NHI or My Number card
Patients
currently applying for or renewing
their insurance card
Patients who have insurance but
forget to bring their card
Please note that the deposit will be required
each
time we are unable to confirm your insurance validity.
Once you present a valid insurance document, we will
recalculate your treatment fee and promptly refund the difference
on the same day.
Thank you for your understanding and cooperation.
What’s your current residency status?
*
Living in Japan
Traveling in Japan
Are you a current patient? Or first time patient?
*
Current patient
First-time patient
Patient Registration Number
*
What are you making an appointment for?
*
Cleaning and checkup
Tooth or gum problem
Implants
Braces
Sedation needed?
Other
Where does it hurt?
*
Upper left front
Upper left back
Upper right front
Upper right back
Bottom left front
Bottom left back
Bottom right front
Bottom left back
Pain Intensity
*
1 - Very Mild
2 - Mild
3 - Discomfort
4 - Noticeable pain
5 - Moderate
6 - Distracting
7 - Severe
8 - Very severe
9 - Intense
10 - Unbearable
When did the pain start?
*
MM slash DD slash YYYY
What type of pain is it?
*
Throbbing
Dull
Shooting
Other
Other symptoms
Swelling
Redness
Sensitive to cold
Sensitive to hot
Additional notes
Message
*
Let us know if you have any special request regarding your appointment.
Phone
This field is for validation purposes and should be left unchanged.
