Health Insurance Society / Health Screening & Medical Checkup designated by Business Establishments
Reservation Request Form

  • Reservations are not confirmed only by submitting this form. We will usually reply to you within 3 business days. In the unlikely event that you do not receive a reply from us after 3 business days, please contact us by phone.
  • This form is a reservation request form for "up to 2 persons". For reservations for 3 or more persons, please contact us using the form below.
  • This form is only for the application for "Health Insurance Society / Health Screening & Medical Checkup designated by Business Establishments" appointment. For any other inquiries such as changes, cancellations, or schedule changes, please contact us using this form.

Registration Form

*Please fill out the registration form below.
If the form does not appear, please wait a moment or wait some time before accessing it again.

About Security

The contents of your inquiry will be encrypted by SSL encryption technology.
Please be assured that your important information will not be exposed to a third party.