Inquiries | Medical Access Japan

Inquiries

Inquiry Type (Required)

Inquiry related to visiting Japan for medical treatment Other inquiry

Select an inquiry type

Contact Information (Required)

Name: Enter your name
Telephone No.: (Example: 03-0000-0000); Enter your telephone number
E-mail: Enter your e-mail address correctly

Inquiry Details (Required)

If medical treatment is required, please provide as many details as possible, including the name of the illness, tests and treatment required, the desired medical institution, etc.

Patient Information

(If the inquiry is related to visiting Japan for medical treatment, please provide as much information as possible.)

Name
Gender: Male Female
Date of Birth: Year: Month: Date:
Nationality: (Example: Japan)
* List the main nationality in the event of multiple nationalities.
Native Language: Japanese English Russian Chinese
Other (list the native language)
Visa Arrangements: Required Not required Not sure
Purpose of the Request: Clinical Tests Treatment Second Opinion
Other (list the purpose of the request)
History and Background of Treatment: (This is only required if treatment is necessary)
Will you be accompanied by someone?: Yes No Not sure

Personal Information

Handling of personal information provided through the “Inquiry form” on this website is as follows.

1. Handling of personal information

As a minimum standard, the Company will disclose the following matters, or matters of an equivalent standard or above, in writing, and receive consent from the customer, before it obtains personal information:
・Name of business operator
Emergency Assistance Japan Co., Ltd.
・Personal Information Protection Manager
Personal Information Protection Manager
General Manager of Management Department
・Provision of personal information to third parties
Personal information obtained will not be provided to any third party unless consent is granted by the customer or it is a legal requirement to do so.
・Delegation of handling of personal information
Handling of all or part of the personal information obtained may be delegated.
・Disclosure, etc. of personal information that is subject to disclosure, and responding to inquiries
The Company will, at the owners request, provide notification of the purpose of use, disclose, amend the content, add to, partially delete, cease using, or completely delete, (hereinafter “Disclosure, etc.”) any personal information that is subject to disclosure obtained by the Company. The contact point for Disclosure, etc. is the relevant “Inquiry form.”
・Voluntariness of providing personal information and the effect of not providing personal information
There are items that must be completed to receive a response.
・Acquisition of personal information by means that are not easily recognizable to customers
The Company does not acquire personal information through means that are not easily recognizable to customer, such as by using cookies and web beacons, etc.
・Personal Information Protection Policy
Refer to the Company’s website to view the Personal Information Protection Policy.

2. Purpose of use

The Company may use personal information obtained from the “Inquiry form” on the Company’s website (including sensitive information) for any of the following purposes and will not use it for any other purposes:

・To respond to inquiries
・To provide international medical coordination services

3. Handling of sensitive information

The Company will not acquire, use, or provide to a third party sensitive information such as information about health status or medical history without the consent of the customer or if required by the Act on the Protection of Personal Information, or other laws, regulations, or guidelines.
Note: Sensitive information refers to sensitive information specified in Article 6 of the Guidelines for Personal Information Protection in the Financial Field.

4. Safety measures

The Company sends personal information provided through the “Inquiry form” on the Company’s website through SSL encrypted communication.
If you agree to the above, enter the required information in the above fields and press the send button.