カウンセリング予約

Fill in the following items and please click confirm

※it is required field

  • Name※
  • Phone number※
    *e.g. 0120005327
  • Mail address※
    *If you have set the rejection of reception by specifying a domain.In that case Please set the setting, Please set “azabuskinclinic.info@gmail.com as domain boarding reception
  • Contact method of return※
    *when confirming your resarvation,please cheeck the return method *If you can not contact us by email ,we will call you
  • Reservation desired date※

    Our clinic is closed on Mondays and Tuesdays.

         First choice※
             2nd choice※
             *If you make a reservation and in a hurry. Please call us within 3 days *Depending on the condition of medical treatment on the day, there maybe cases where the medical treatment time will be delay on the time of reservation.It is highly likely that you will have to wait especially on Saturdays. We will make every effort to provide medical treatment and treatment at the time you make a reservation, but please note that it may past the reservation time.
  • Gender※
  • Age※
  • Nationality※
  • Skin type※
  • Hair colour
    Only for hair removal
  • Desired treatment
    (multiple selections allowed)※

    Parts
    Skin color
    Hair color
  • how did you know our clinic
  • motivation and worries for treatment
  • searched key word
    *If you like please fill in the search keyword
  • Have you ever had
    a COVID-19 infection before?
  • If you have, are you currently
    experiencing the symptoms?
  • If you are no longer experiencing
    the symptoms, have your symptoms stopped
    more than 14 days ago?

  • ※For those who have the experience of COVID-19 infection, if your symptoms haven’t stopped for more than 14 days, you are not able to have the appointment at our clinic.
    If you currently experiencing symptoms such as fever, sore throat etc. you are unable to have the appointment as well.

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