Application form

To contact us

Use the form below to contact us by email. Someone from our hospital will reply within 3-7 working days. If it is urgent call us at 0776-23-1111. (we will not be able to speak in English)

Place of work(optional)
Work Number(optional)
Name
Last 
First 
Sex
(Home) Address (in Japan) ZIP
Telephone (number) May we call at this number in case we need to contact you?

Best time to call (on Friday only)
Fax (number)
E-mail ※We will respond to your inquiry to the email address above.
Type of inquiry
Inquiry/Comments here
...Must input information)
 

0776-23-1111

Funabashi 7-1, Wadanaka-cho, Fukui City,
Fukui 918-8503 JAPAN.

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