Online Speech Therapy | OHドクター

Appointment Form

※The latest reservation time is before 12 pm on 3 days ago.
※If you want to change the time after making an appointment, the latest deadline is before 12 pm on the day before the appointment.

Preferred Day

First choice of the dayRequired
Second choice of the dayRequired

Which do you prefer?Required
Preferred LanguageRequired
NameRequired
AgeRequired
GenderRequired

MaleFemale
Date of birthRequired
Are you over 18?Required

YesNo
Phone number
Email addressRequired

Please enter the details of your consultation.

Do you have a medical diagnosis such as stroke, brain disease, Parkinson's disease, or Alzheimer's disease (dementia)?

Please enter the details of your consultation.

Which languages does your child use in daily life? What are the approximate percentages of the different languages used?

When did your child say their first words, such as Dad, Mom, etc.?