CHC Inquiry Form

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CHC Inquiry Form

Notifications

  • Depending on the content of your inquiry, we may not be able to answer it or we may ask you to contact us by phone.
  • We will handle inquiries from 8:30 AM to 5:00 PM on weekdays.
  • We will answer inquiries within a few days. (Over the weekends, we will need more time than usual.)
    Also, according to contents, we may need extra time. We kindly ask for your understanding.
  • As for contents, we will manage them appropriately based on our hospital’s personal information protection guidelines.

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Name* Family Name   First Name 
Phone number
E-mail address* ex：iizuka@aih-net.com
E-mail Address
(For confirmation)*		 ex：iizuka@aih-net.com

For confirmation, please reenter your e-mail address.
Please do not copy and paste from above.

Comments*

*Required field.

*For contents written above, we will manage them appropriately based on our hospital’s personal information protection guidelines.