Appointment

meclogoMinamiaoyama Eye Clinic Application Form

  • Your appointment will be confirmed only when a member of our clinic staff contacts you by e-mail.
  • It takes a couple of days to reply your E-mail. Please call us if you have any urgent request.
  • This appointment form is for pre-surgical examinations only.
    For all other appointments, please make your appointment here.
  • Currently, appointments are fully booked. Please schedule your appointment for a date at least two weeks from now.

    Consultation content*


    What is the reason for consultation?

    First&Last name*

    Phone or cell phone*

    E-mail Address*

    E-mail Address（Re-type）*

    Gender*
    MaleFemaleOther

    Age*

    ※Clinic close on Tuesday and Monday holiday .Currently, appointments are fully booked. Please schedule your appointment for a date at least three weeks from now.

    1st choice*

    2nd choice*

    3rd choice*

    If there is an emergency, please call us.(03-6633-4872)

    Reservation must be notified a few days in advance.


    Your correction procedure*
    GlassesSoft contact lensesHard contact lensesNothing

    Your past visits*
    YesNo

    Patient ID(Identification) card number

    Past history(e.g.LASIK)*
    YesNo


    Content of inquiry

    Notes

    • If there is no reply even 10minutes or more, please call us(03-6633-4872).
      （9:30～18:00　clinic close on Tuesday and Monday of National holiday）
    • It takes about 2 hours for surgery examination and consultation.
    • We will put some medicine in your eyes to open your iris.
      Please do not come to our clinic by car.
    • The examination charge for the LASIK,SMILE,PRK,and ICL is Free. Orthokeratorogy, we charge 3,000JPY for the examination. The rental charge for the trial lens is free.
    • If communication in Japanese or English is difficult, patients are kindly requested to bring their own interpreter. Please note that when an interpreter accompanies the patient, an initial suitability examination fee of 20,000 yen will apply.
    • We will charge 20,000 yen for a second opinion for patients who have received refractive surgery (LASIK, ICL, etc.). If an interpreter accompanies the patient, the fee will be 40,000 yen.

    ※Minors must be accompanied by an adult.