Mail form

Mail form

Attention

  • It will be used only International Medical Bridge and hospital or hospitals.
  • The information he/she wrote in e-mail is taken very carefully.
  • If you missed the blank to fill, you may not receive the service.
  • If you are under18 years old, you need parent permission.
  • A question and requests are acceptable only by e-mail.

Mail form

Press the confirmation button after filling in the mandatory.
「*」 Mark is a required item.

Request Type*
Name*
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Email*
Zip code
Address
Comments*

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Contact us

Please feel free to ask. By telephone or mail form.

tel.+81-3-3868-3972

Open Mon.-Fri. 10:00 to 18:00 JST. Weekends and holidays are closed.