We accept appointment requests for referred patients by fax.
※ We only accept referrals from medical institutions that have prepared a “Medical Information Referral Letter”.
We do not accept fax appointment requests directly from patients.
Please note this carefully to avoid any confusion.
Please print the “Referral Patient Fax Appointment Request Form” from the PDF below, fill in the required fields, and send by fax.
※ For Ophthalmology, the appointment process and form differ from other departments. Please confirm by phone.
※ If the “Medical Information Referral Letter” is ready, please attach it to the fax appointment request form and send together.
If not yet completed, please write the patient’s diagnosis in the “Remarks” section of the fax appointment request form.
| Dedicated Fax for Appointment Requests | 0178-31-1767 ※ Same-day appointments cannot be accepted. |
| Reception Hours | Weekdays 9:00–17:00 ※ Faxes sent on closed days or outside the above hours will not be accepted. |
Once we receive your fax, we will process the outpatient appointment and send a confirmation fax in return. (Please note that there may be a delay in sending the confirmation fax due to patient care and other circumstances. We appreciate your understanding.)
If we are unable to accommodate your preferred physician or appointment date, we will contact you by phone.
When visiting our hospital, please bring your My Number Card (registered for use as health insurance), health insurance eligibility certificate (or public assistance certificate, etc.), the “Medical Information Referral Letter,” your medication notebook, and if currently hospitalized at another institution, a certificate of hospitalization. Please proceed to the new patient reception.
If you have previously visited our hospital, please also bring your hospital registration card.