English: Please not that only those who have already made an appointment can request an initial consultation.
The first question asks whether you know the number of your patient card, please select the first option if you do, the second if this is your first consultation, and the third if you are already a patient but cannot remember your number. The first box you can type in is where you enter your patient number (excluding any initial zeros). The second box is where you state when your planned day of visit is. The final two boxes are where you enter your name (first row can be in English or Japanese, the second row preferably in katakana). The English questions are available from the next page.