Form（New patient）MandatoryConsultation contentHair removal consultationBeauty consultationMandatorydesired locationShinjuku ClinicIkebukuro ClinicUeno ClinicYokohama ClinicMandatoryBeauty project you want to implementHIFUderma penderma pen+peelingmassage peelpeelingbeauty dripwhitening dripHigh-strength cellulose C dripbotoxmole removalConsultationNoticeThere is no need to make an appointment for cosmetic injections.Q switch yag laser is Shinjuku Clinic’s exclusive project.MandatoryBeauty project you want to implementHIFUderma penderma pen+peelingtoningfractional toningstain removalmassage peelpeelingbeauty dripwhitening dripHigh-strength cellulose C dripbotoxmole removalhair growth treatmentConsultationNoticeThere is no need to make an appointment for cosmetic injections.MandatoryBeauty project you want to implement(multiple choices available)derma penderma pen+peelingmassage peelpeelingbeauty dripwhitening dripHigh-strength cellulose C dripbotoxmole removalhair growth treatmentConsultationNoticeThere is no need to make an appointment for cosmetic injections.Q switch yag laser is Shinjuku Clinic’s exclusive project.MandatoryDesired treatment timeDesired date：hope time09:00〜12:0012:00〜15:0015:00〜17:0017:00〜19:00MandatoryDesired treatment timeDesired date：hope time09:00〜11:0011:00〜13:0013:00〜15:0015:00〜17:0017:00〜19:0019:00〜21:00(Saturdays, Sundays, and holidays cannot be chosen.)MandatoryDesired treatment timeDesired date：hope time09:00〜11:0011:00〜13:0013:00〜15:0015:00〜17:0017:00〜19:0019:00〜21:00(Saturdays, Sundays, and holidays cannot be chosen.)MandatoryDesired treatment timeDesired date：hope time09:00〜12:0012:00〜15:0015:00〜17:0017:00〜19:00MandatoryDo you want to have surgery on the same day?(After consulting)YesNoMandatoryHope areas(multiple choices available)Whole body (excluding face and VIO area)Whole body+FaceWhole body+VIO areaWhole body+Face+VIO arealeft and right armsFrom the left and right toes to the top of the thighbody partsVIO areaface areaBeard hair removal 10 timesOther individual parts (please fill in the Questions＆Consultation column below for details)consultMandatoryNameMandatoryGenderMaleFemaleDon't want to answerMandatoryEmail addressMandatoryPhone numberArbitraryQuestion＆Consultation Number of characters remaining： 250Notes have been read and agreed
