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Patient Intake Policy
Please read the following if you are visiting us for the first time.
In order to provide quality care to our patient, we see patients on appointment only basis.
Please call the number below first to book an appointment with us
TEL：03-5469-0810
About patient intake forms
Before we begin your treatment, you are required to download the applicable forms below and fill them out before your visit.
※Adobe Reader is required to access our patient intake form. if you do not have Adobe Reader, you can download it by clicking the logo below. （Adobe Reader is free）
If you have any trouble downloading and printing our forms, they are also available at our office. You may either pick them up, or contact us by phone or email if you would like them mailed to you, or fill them out at our office before your first visit.
Downloadable Forms
Complete set of forms for Infertlity Treatment (Women) Click Here
Patient Information
Medical History
Health History
Women's Fertility History
Form for Male Infertility Click Here Form 1
Men's Fertility History
Please also download this which includes the forms below Click Here Form 2
Patient Information
Medical History
Health History
