Initial visit request

If you hope to visit within 2 days, please use the form below or call.

Telephone 078-515-6025 support and in-person reception are available in Japanese only. Please arrange an interpreter if needed.

Use this form to request an initial visit or consultation.
Your appointment is confirmed only after the clinic contacts you.

This page uses SSL (Secure Socket Layer) encryption to protect personal information.

* indicates a required field.

Eligibility for treatment under Japan's public health insurance

Coverage is available only to patients with valid Japanese public health insurance eligibility. Without eligible coverage, treatment is generally self-pay.

Passport or romanized name

Confirm email address

Telephone number (international format accepted)

Country or region of residence

Preferred language for contact (availability is not guaranteed)

Interpreter arrangements

Japanese public health insurance

Planned arrival date in Japan (optional)

Planned departure date from Japan (optional)

Preferred contact method

Request type

Initial visit under Japan's public health insurance Self-pay consultation only Request same-day self-pay treatment

Consultation or treatment details

First preferred date (closed Tuesdays and Sundays)

Preferred time (multiple selections allowed)

Second preferred date (closed Tuesdays and Sundays)

Preferred time (multiple selections allowed)

Privacy policy

Minato Motomachi Beauty and Plastic Surgery Clinic (the “Clinic”) handles personal information collected through this website appropriately.

Purposes for using personal information

Providing information about appointments, care and consultations
Responding to inquiries and verifying identity
Necessary care-related communication and important notices
Providing and operating services and preventing misuse

Disclosure to third parties

Except where permitted by law, the Clinic does not provide personal information to third parties without the individual’s consent. Contractors are required to manage information appropriately within the necessary scope.

Disclosure, correction and suspension of use

Requests for disclosure, correction, addition, deletion or suspension of use are handled under applicable law and the Clinic’s procedures.

Contact point

Minato Motomachi Beauty and Plastic Surgery Clinic
5-3-3 Motomachidori, Chuo-ku, Kobe 650-0022, Japan
Email: nieclinic.com@gmail.com

I agree to the handling of my personal information.