Reservation｜Tokiko Clinic

Reservation

Please fill in the form below if you want to visit our clinic. Please make sure to enter three choices for your appointment date.
We will e-mail or call you to confirm the date and time of your visit. Please be advised that your appointment has not been accepted until we get in touch with you.

※ Please note that sending the Web appointment form does not mean your appointment has been accepted.
※ We will endeavor to reply to your request within 24 hours except for Sundays, public holidays and other non-business days.
※ Please call for an appointment if you are in a hurry.

Reservation by phone

We welcome a reservation by phone

■Tokiko Clinic　TEL：06-6241-6663 10：00～19：30
■Tokiko Clinic Medical Spa　TEL：06-6241-6657 10：00～19：30

Reservation Form

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

Reservation Form
Reservation content ※	Examination and counseling only Treatment after examination and counseling Treatment at Medical Spa
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）
Date and time choices ※	1st choice Month： Date： o’clock：： 2nd choice Month： Date： o’clock：： 3rd choice Month： Date： o’clock：： ※ Please see the operating hours and select the date and time ※ Please type up to third choices since it may be crowded Treatment Hours >>
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