For hospitals and commercial labs

  • 1.
    Input screen
  • 2.
    Confirmation screen
  • 3.
    Completion screen

Please complete the following form. After confirming the content of your inquiry, the appropriate department will respond.
After you have entered the necessary information, click on button labeled “Proceed to Confirmation Page” to check the information you have entered.
Required=Required fields)

RequiredSubject
RequiredName Last Name First Name
RequiredInstitution or Company
RequiredDepartment
OptionalAddress

Prefecture

City Address

Building or Apartment Name

RequiredTelephone
OptionalFax
RequiredE-mail Enter Again to Confirm
RequiredComment

When requesting a document, please make sure to enter your address.
The personal information you enter here will not be used for other purposes.
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