Free Counseling｜Tokiko Clinic

Free Counseling by email

Tokiko Clinic offers a free consultation service. Please feel free to ask about any problems or questions concerning any aesthetic medical issue; from aesthetic dermatology, aesthetic therapy, plastic surgery to anti-aging.
Please fill in the following form with the required information and press the “send” button. For a consultation with our beauty concierges, pop over and visit us at the clinic. These are all free.

Inquiry form

※ The marked items are compulsory. Please make sure to send us the correct and complete form.

Reservation Form
Inquiry type ※
Name ※	（Surname First name）
Sex ※	Female Male
Range of age
Type mail address （one-byte） ※	（one-byte number）
Retype mail address （one-byte） ※	（one-byte number）
Prefectures you are in
Telephone number - - （one-byte number）	（one-byte number）
Treatment menu ※
Please write your messages, inquiries about treatments and your symptoms in detail.
Reasons of this site visit （multiple entries allowed）	From friends Searched by Google Searched by Yahoo Searched by other search engines Pamphlet Others