BOOKING FORM

PLEASE FILL THESE INFORMATIONS BELOW.

BOOKING CALENDAR

※ 15 minutes per person.
※ If you booking before 12:00 noon, you can get an appointment on the same day.

Otolaryngology
／Examination Only
（Dr. Okina）		 Mon Tue Wed Thu Fri Sat Sun
21:00-22:00 ◯ ー ー ー ◯ ー ー
Internal Medicine
／Consultation Only
(Dr. Egawa)		 Mon Tue Wed Thu Fri Sat Sun
20:00-21:00 ー ◯ ー ー ー ー ー
Internal Medicine
／Examination・
Consultation
(Dr. Jo)		 Mon Tue Wed Thu Fri Sat Sun
20:00-22:00 ◯ ー ◯ ◯
1/13✕		 ◯ ー ー
Internal Medicine
／Consultation Only
(Dr. Oza)		 Mon Tue Wed Thu Fri Sat Sun
20:00-22:00 ー ー ー ー ー ー ◯
Dermatology
／Consultation Only
（Dr. Sugimoto）		 Mon Tue Wed Thu Fri Sat Sun
20:00-21:00 ー ー ー ◯ ー ー ー
Pediatrics
／Consultation Only
（Dr. Kashimada）		 Mon Tue Wed Thu Fri Sat Sun
20:00-21:00 ー ー ◯ ー ー ー ー
Internal Medicine
／Consultation Only
(Dr. Oza)		 Mon Tue Wed Thu Fri Sat Sun
20:00-22:00 ー ー ー ー ー ー ◯

    Clinical Department・Language

    1. ※Otolaryngology is available only for medical examination.

      Medical Examination
      (Available for prescribing medicine)      		 Otolaryngology／Internal Medicine
      Medical Consultaion
      (Unavailable for prescribing medicine)      		 Internal Medicine／Dermatology／Pediatrics／Urology

    Which do you prefer?

    1. Medical consultation system usage fee
      Medical examination system usage fee＋medical examination fee(＋medicine fee＋medicine delivery fee)
      • ※Prescribing medicine is allowed only for medical examination.
        If the doctor decides that medicine is necessary for you during the medical consultation, please book an new appointment for medical examination.
      • ※Pharmacist will contact you and tell how to take medicine around 1:00 pm~3:45 pm on the next day after the medical examination if you are prescribed medicine.
      • Please kindly note that the cancellation of filling your prescription which has been issued is not allowed.

    Language

    1. Required

    Preferred Day

    ※Same-day appointment is available if you book an appointment before 12 p.m. on the day.

    1. First choice of the dayRequired
    2. Second choice of the dayRequired
    3. Third choice of the dayRequired

    Basic Information

    1. Payment method（system usuage fee）
      Payment method（system usuage fee＋medical examination fee）
      Medical Consulation System usage fee Credit Card,
      Convenience store postpaid
      Medical Examination System usuage fee＋Medical examination fee Credit Card,
      Convenience store postpaid
      Medical fee, Medical delivery fee NP Atobarai

      ※The payment URL will be sent to you by e-mail after the medical consultation/consultation is completed. The invoice will be mailed to the address you specify within a few days to a week.

    2. Please kindly let us know your situation in OH Dr..
    3. If this is your first visit or your first visit this month, you will need to upload your health insurance card image.(Max number of files allowed: 2)
      • Please note that if you do not have your Japanese health insurance card, you have to pay full cost.
        If you do not have your Japanese health insurance card, please upload a image of a valid document with your photo and address (e.g. a driver's license).
        ※If you are having trouble in uploading your images, please kindly send photos to support@oh-doctor.com.

    4. Please upload a photo of the affected area.(As much as possible/Max number of files allowed: 2)
    5. Required
    6. Required
    7. Required
    8. Required
    9. Date of birthRequired
    10. Required
    11. GenderRequired
    12. Required
    13. Required
      kg

    Medicine and Prescription・Delivery Information

    1. Japan

      Required
    2. Required
    3. Required
    4. Required
      of the next day
      • ※Pharmacist will contact you by phone and tell how to take medicine at your preferred time on the next day after the medical examination.
        ※If you select "Unavailable", we will contact with you later.
      • ※We will ship out your medicine after online medicine instruction is done by phone. Therefore, there is a chance that the medicine is delayed depending on the situation. We would appreciate it if you could understand.
    5. Request for generic drugRequired

    Medical Consultation

    1. Required

    Medical Examination

    1. What are your symptoms? Please check appropriate box.Required
    2. When did the above symptoms start?Required
      • If you are experiencing these symptoms more than 1 week, please kindly tell your doctor when medical examation.
    7. Required
      cigarette(s) per day
    8. Required
    9. Have you ever been diagnosed with allergies? Please check appropriate box.Required
    10. Do you have any blood relative who has been diagnosed with asthma?

    Online Medical Consultation Terms of Service
    Online Medical Examination Terms of Service

    ※Please click "SEND" if you agree.

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