Preview / Consultation Reservation Form

Please note that reservations for previews are currently suspended.

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ご相談場所 ※ご相談のご予約のお客様のみご入力ください。

If you specify your home, our staff will visit you at the desired date and time.

Due to business reasons, we may not be able to visit you on the desired date and time. In that case, we will contact you again.

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We may not be able to meet your request due to business reasons. In that case, we will contact you again.

Information of the person who uses the service

性別<必須>
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To learn more about the Certification of Needed Long-Term Care, the Ministry of Health, Labor and Welfare website q Please confirm.

Applicant information (family information, etc.)

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We may not be able to meet your request regarding the date and time of the preview and consultation. Please note.

It may take some time to answer. If you are in a hurry, please contact us by phone.

TEL: 0766-86-8857

■ Purpose of use

The personal information you enter will be managed based on our personal information protection policy, and will be used only for responding to and responding to inquiries and inquiries.

■ To those who submit the form

Please be sure to read the above "Purpose of Use" and " Privacy Policy r ", and if you agree, check "Agree" and click the "Send" button.

Transmission completed

At the same time as sending the application details, we will send you an email notifying you that the reception has been completed.

If you do not receive the email, the email address you entered may be incorrect.

Sorry for your inconvenience, but please enter the correct email address and apply again.