Request a first visit (questionnaire)

Contact

A first visit at our clinic begins with a first consultation (examination and diagnosis). Questions about a diagnosis or treatment plan you received elsewhere are also covered within it. Please start with the questionnaire below. We will read it and reply by email, usually within two clinic days, with proposed dates and what to bring. We do not diagnose or decide treatment by email. Appointments are currently booked five months ahead; please expect a wait before your visit.

In an emergency, such as being unable to chew or having severe symptoms, please call us on 042-795-1359 (Japanese).

How a first visit works

First Consultation

We examine jaw movement, bite and teeth, then explain our initial findings, any further examinations needed, and the treatment options with costs, duration and number of visits.

30 minutes to 1 hour
Private fee: see the fee table

Bring: any records from other clinics

The first consultation is a private (non-insured) service. If you are looking for insurance-covered treatment only, we recommend a clinic near you. After the diagnosis, you may decide not to proceed with treatment at our clinic.

From enquiry to your visit

  1. 1

    Send the questionnaire

    Use the form below.

  2. 2

    We reply

    Usually within two clinic days, by email, with proposed dates and what to bring. You can attach photos of records from other clinics to your reply.

  3. 3

    Visit and diagnosis

    Examination and diagnosis, then an explanation of treatment options with costs, duration and number of visits.

  4. 4

    Treatment (if you wish)

    Decide after reviewing the treatment plan and estimate.

Questionnaire

Items not marked “Required” are optional. Please fill in what you can.

About you

Preferred way to contact you

How you found us

How did you hear about us

Your consultation

What you are looking for Required
What concerns you (select all that apply)
How many clinics have you consulted about this?
Records you have (select all that apply)

About dental treatment

Have you ever felt unwell during dental anaesthesia or treatment?
Your wishes about treatment (select all that apply)

Health

If nothing applies, please write “None”.

Pregnant or possibly pregnant

We ask this to decide on X-ray imaging.

Breastfeeding

We ask this to decide on medication.

Smoking Required
Alcohol Required

Work and emergency contact

The phone number of your workplace or school, and when it is easiest to reach you there.

One person other than yourself. Please write their name, relationship to you and phone number.

Preferred visit times

Days and times that suit you (select all that apply)

The clinic is open Monday, Tuesday, Thursday and Friday (closed Wednesday, weekends and public holidays).

Mon · Tue · Thu · Fri 10:00–13:00 / 14:30–18:00

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