• Name※

• Residential situation※

  Resident Tourist

  How long you will stay in japan?
  

• 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※

  Phone Mail Either is acceptable *when confirming your resarvation,please cheeck the return method *If you can not contact us by email ,we will call you

• Reservation desired date

  【Closed on Monday & Tuesday】

       First choice      10:00～12:00 12:00～13:30 15:00～17:00 17:00～19:30 anytime 2nd choice      10:00～12:00 12:00～13:30 15:00～17:00 17:00～19:30 anytime *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※

  Female Male Other

• Age

  below 19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 above 60

• Nationality

• Desired treatment

  Procedure of Interest

  Pigmented Spots Acne, Acne Scars Scarring Hormone Laser Hair Removal Other Medical Skin Issues

  The laser will work on melanin. In this case, laser hair removal is ineffective for light-colored hair.

• Free Entry Field