PCR Test Application page

  • input
  • Confirmation
  • completion

Enter the following items and press “Confirm input”.

※You cannot make reservations or changes to your health checkup on this form. Please choose “Medical examination new reservation form” or “Medical examination reservation change form.”

※ If you would like to get vaccinated, please select “Vaccine provisional application form.” Please select.

※Please check the frequently asked questions, “Q&A

Full NameRequired
SexRequired
Date of BirthInoculation
Phone numberRequired
EmailRequired Please enter again for confirmation ※We will send the WEB medical examination and WEB results to the email address you entered
Your DestinationRequired
Consultation clinicRequired
Inspection content / certificate issuance selectionRequired
payment methodRequired
Number of peopleRequired ※The number of people who take the test that you've chosen.
Reservation / No reservationRequired
Date and timeRequired
 ~ 
Reservation timeRequired
reception MON TUE WED THU FRI SAT SUN
AM ( 8:45-11:10)
PM (13:00-16:30)
EV (18:00-19:30)
In case of multiple people, all names
Names of all Visitors get PCR TestRequired
Name of the specified formRequired ※Prescribed Form
other inquires
optional