Business hours are as follows
10:00am - 5:00pm
Closed on
Saturdays, Sundays and public holidays

Please feel free to contact us

Please fill in the form below and submit to us by clicking “send” bottom.

Absolutely no fees will arise at the time of your application. 

Whether you have a query or need some information, our team is available to help via phone or
contact form. Please feel free to contact us.
    

Regenerative Medicine Treatment Application
Form and Questionnaire 

※ Orange colour (必須) indicates mandatory field. Please fill in or select all mandatory fields.

必須

(ex. John Smith)

必須
任意
必須

(ex. 06/14/1952)

必須

(ex. 1234 West New Haven, Apartment #23, Jamestown, WV, 55555, USA)

必須

(ex. Office worker, None, etc.)

必須
必須

(ex. +1-310-123-4567)

必須
任意

(ex. +1-212-123-4567)

任意

(ex. sample@john.com)

必須
任意
必須
任意
任意
必須
任意
任意
必須
任意
必須
任意
任意
必須
任意
必須
任意
必須
任意
必須
任意

(ex. Around ten cigarettes a day for 20 years)

必須
任意

(ex. a can of beer four times a week)

必須
任意

(ex. jogging everyday)

必須

(例:185)

必須

(例:81)

任意
任意

(ex. 18 weeks)

任意

* After clicking the button above, it may take 4-5 secs before the next screen is dis-played.
So please don't click the button again during this period.


If you fail in sending your message, please send it directly to the following address.
office@jrmc.jp

* After clicking the button above, it may take 4-5 secs before the next screen is dis-played.
So please don't click the button again during this period.


If you fail in sending your message, please send it directly to the following address.
office@jrmc.jp

Results of examinations at our Medical Center may be used for purposes including, but not limited to, creating research documents for presentations at academic conferences. In these cases, we will use
the results to work towards the development of regenerative medicine in Japan bearing in mind
privacy and taking care that no individuals can be identified. 

                                 Thank you for your cooperation. 

Please feel free to contact us

Business hours are as follows 10:00am - 5:00pm (Closed on
Saturdays, Sundays and public holidays)

The contact form is available 24/7.