All fields are required unless marked optional.

Appointment Form


Personal Information

 
Email
First Name
Last Name
Date of Birth
Gender
City of Residence
Used JMT service before?
Mobile Phone
Preffered Language

Appointment Information

 
Arriving in Japan
Appointment Date First Choice From to (optional)
Appointment Date Second Choice From to (optional)
Appointment Type Requested (optional)
Need Accommodation (optional)
Need Charter Jet (optional)
Trip Type (optional)
Flight Type (optional)
Aircraft Type (optional)
Number of Passengers (optional)
Additional Information (optional)

Medical Inquiry Information

 
Type of Inquiry
Treatment Procedure 1
Treatment Procedure 2
Treatment Description
When do you like to be treated
I inquire for
Your Question
Captcha

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A. TERMS OF USE
By submitting this appointment form, I agree that:

  1. Making an appointment on this website with JMT is for scheduling only. JMT, its employees, any physician or clinician with whom an appointment has been made by use of this website has not agreed to provide the undersigned with any medical advice, diagnostic or therapeutic procedure until the undersigned has registered in person at a designated facility.
  2. Any dispute or claim (including injury claims) related to health care services received from JMT and its affiliate organizations that is not resolved by mutual agreement is subject to Japanese law and the exclusive jurisdiction of the appropriate court in Japan.

B. Note: Clicking the Send button indicates agreement to the Terms of Use.

C. Clear form-

D. Response Time: JMT will reply within 72 hours for Appointment requests. Please contact us if appointment requests are not answered within the time frame.