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. Full Name Phonetic (kana) Date of birth Gender FemaleMale Phone number Email address Confirm Email address Zip code Address1 (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 Reason for testing Contact with a Covid-19 positive personOther Other: Request for certificate Certificate is not necessary, only the report of the test result.Certificate in Japanese (5,500 yen including tax)Certificate in English (5,500 yen including tax) 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.