Form（Revisit）Mandatorydesired locationShinjuku ClinicIkebukuro ClinicUeno ClinicYokohama ClinicMandatoryBeauty project you want to implement(multiple choices available)Hair removalHIFUderma penderma pen+peelingmassage peelpeelingbeauty dripwhitening dripHigh-strength cellulose C dripbotoxmole removalDiet (Rybelsus, oral administration method)Diet (Mounjaro, self-injection method)IsotretinoinConsultationNoticeThere 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 implement(multiple choices available)Hair removalHIFUderma penderma pen+peelingtoningfractional toningstain removalmassage peelpeelingbeauty dripwhitening dripHigh-strength cellulose C dripbotoxmole removalhair growth treatmentDiet (Rybelsus, oral administration method)Diet (Mounjaro, self-injection method)IsotretinoinConsultationNoticeThere is no need to make an appointment for cosmetic injections.MandatoryBeauty project you want to implement(multiple choices available)Hair removalderma penderma pen+peelingmassage peelpeelingbeauty dripwhitening dripHigh-strength cellulose C dripbotoxmole removalhair growth treatmentDiet (Rybelsus, oral administration method)Diet (Mounjaro, self-injection method)IsotretinoinConsultationNoticeThere is no need to make an appointment for cosmetic injections.Q switch yag laser is Shinjuku Clinic’s exclusive project.MandatoryHope 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)consultMandatoryDesired 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 time09:00〜12:0012:00〜15:0015:00〜17:0017:00〜19:00MandatoryDesired treatment time Desired date：hope time09:00〜12:0012:00〜15:0015:00〜17:0017:00〜19:00MandatoryNameMandatoryGenderMaleFemaleDon't want to answerMandatoryDate of birth(Enter 8 digits of the Western calendar year)MandatoryEmail addressMandatoryPhone numberArbitraryQuestion＆Consultation Number of characters remaining： 250Notes have been read and agreed
