If you are reserving for more than one person, please enter one person at a time and fill in the name of the accompanying person in the comments below. Attestation prior to testing I do not currently have cold symptoms or symptoms suspicious of Covid-19 infection such as fever of 37.5 °C or higher, taste or odor abnormalities, cough, shortness of breath, or general malaise. I do acknowledge and agree to the terms of the 「Please read if you intend to travel abroad.」 on the 「Covid-19 Antigen Testing page」 Full Name Phonetic (kana) Gender FemaleMale Phone number Email address Confirm Email address Zip code Address 1 (Prefectures) ---HokkaidoAomoriIwateMiyagiAkitaYamagataFukushimaIbarakiTochigiGunmaSaitamaChibaTokyoKanagawaNiigataToyamaIshikawaFukuiYamanashiNaganoGifuShizuokaAichiMieShigaKyotoOsakaHyogoNaraWakayamaTottoriShimaneOkayamaHiroshimaYamaguchiTokushimaKagawaEhimeKochiFukuokaSagaNagasakiKumamotoOitaMiyazakiKagoshimaOkinawa Address 2 (City) Address 3 (street address, building name) Date and time you wish to make a reservation 1st Choicemon. d. 08：3009：0009：3010：0010：3011：0011：3013：0013：3014：0014：3015：0015：3016：0016：30 2nd Choicemon. d. 08：3009：0009：3010：0010：3011：0011：3013：0013：3014：0014：3015：0015：3016：0016：30 How you wish to be contacted regarding your reservation date and time Contact by phoneContact by e-mail Please note that the following items will be reflected in the travel certificate as entered . Please enter exactly as written in your passport. Last name (as written in passport) First name (as written in passport) Date of birth Passport No. Nationality Name of destination country Name of destination city Transit Country NoneYes Transit Country/via: Boarding flight date and time Comments: When you have submitted an application, an automatically generated e-mail will be sent to you. If you use a free email or mobile email, please add our domain ‘@tokyocancerclinic.jp’ on the e-mail settings screen. Especially for Hotmail user, we recommend that you use email address except Hotmail if possible. Or, please be sure to add our domain to your email Safe Senders List. In case you do not receive the automated email response, please contact us by phone.