Questionnaire 2 before Concierge Interview Confirm whether the information disclosed on the website needs to be reiterated in the concierge interview.

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please read our website before the concierge interview. During the concierge interview, we will not read out the same information on our website, but if you would like to know more about this or that point on the website, we will explain it to you in detail during the interview. Please let us know below if you have any questions about the website information, or if you would like to request an explanation.

Email *

First Name *

Last Name *

1.Regarding the results of our Intestinal Microbiota Transplantation service, please check the box if you have read the article.

Please check the box if you have read the article.　

Patient Testimonials - Autism Spectrum Disorder (ASD) https://fmt.sym-biosis.co.jp/en/cases/asd

Patient Testimonials - Ulcerative Colitis https://fmt.sym-biosis.co.jp/en/cases/uc

Patient Testimonials - Allergic Diseases https://fmt.sym-biosis.co.jp/en/cases/allergy

1-2. If you have any questions about the article on the results of our Intestinal Microbiota Transplantation service, please fill in your questions.

2.Regarding the general fecal microbiota transplantation (FMT) service

Please check the box if you have read the article.　

What is Fecal Microbiota Transplantation (FMT)? https://fmt.sym-biosis.co.jp/en/about

Intestinal bacteria flora transplant process https://fmt.sym-biosis.co.jp/en/transplantation/

Watch the video Transplantation process of intestinal bacteria (plexus) https://fmt.sym-biosis.co.jp/en/transplantation/

Cost of Fecal Microbiota Transplantation https://fmt.sym-biosis.co.jp/en/transplantation/fee/

Collaboration with Medical Institutions https://fmt.sym-biosis.co.jp/en/transplantation/cooperation/

Medical facilities where transplants can be performed https://fmt.sym-biosis.co.jp/en/transplantation/partner/

Frequently Asked Questions about Fecal Microbiota Transplantation https://fmt.sym-biosis.co.jp/en/faq/

Frequently Asked Questions about Fecal Microbiota Transplantation utilizing our Nano Bubble Technology https://fmt.sym-biosis.co.jp/en/faq/

Frequently Asked Questions about the Donor Bank https://fmt.sym-biosis.co.jp/en/faq/

The process of transplanting intestinal bacteria (flora) https://fmt.sym-biosis.co.jp/en/faq/

About the day of transplantation https://fmt.sym-biosis.co.jp/en/faq/

Frequently Asked Questions about During and After the Transplantation https://fmt.sym-biosis.co.jp/en/faq/

2-1. If you have any questions about the article on the general fecal microbiota transplantation (FMT) service, please fill in your questions.

3-1.Regarding features of Shinbiosis' Fecal Microbiota Transplantation (FMT) Service

Please check the box if you have read the article.

What is the NanoGAS®-FMT method? https://fmt.sym-biosis.co.jp/en/about/

7 Features of NanoGAS®-FMT https://fmt.sym-biosis.co.jp/en/about/

Autism Spectrum Disorders Initiatives https://fmt.sym-biosis.co.jp/en/asd/spectrum/

Renal Disease Initiatives https://fmt.sym-biosis.co.jp/en/asd/kidneydisease/

How We Differ https://fmt-japan.org/en/technical-features

Characteristics of NanoGAS® water https://fmt-japan.org/en/technical-features

About the Donor Bank https://fmt-japan.org/en/technical-features/japanbiome

List of Diseases that hat has been pointed out to be associated with the Gut Microbiota https://fmt-japan.org/en/technical-features/japanbiome

Donor Bank- Verification of Donor Characteristics to be Selected https://fmt-japan.org/en/technical-features/japanbiome

Donor Bank - Comparison of flight banks in Japan and overseas https://fmt-japan.org/en/technical-features/japanbiome

Donor Bank- Ethics committee https://fmt-japan.org/en/technical-features/japanbiome

Donor Bank- Donor stool management https://fmt-japan.org/en/technical-features/japanbiome

Donor Bank- External information provision and reporting system https://fmt-japan.org/en/technical-features/japanbiome

3-2.If you have any questions about features of Shinbiosis' Fecal Microbiota Transplantation (FMT) Service, please fill in your questions.

4.Regarding case reports:

Please check the box if you have read the article.　

https://fmt-japan.org/en/research_activities/fmt_cases_index

5.Regarding Adverse Events:

Please check the box if you have read the article.　

https://fmt-japan.org/en/research_activities/adverse-event

6.Regarding Original Research Papers and Articles:

Please check the box if you have read the article.　

https://fmt-japan.org/en/research_activities/study

https://fmt-japan.org/en/research_activities/original_papers

7.Regarding academic conferences:

Please check the box if you have read the article.　

https://fmt-japan.org/en/research_activities/conference_index

8-1.Regarding Shinbiosis Coporation

Please check the box if you have read the article.　

About Shinbiosis Coporation https://sym-biosis.co.jp/en/our-story/

Company Profile https://sym-biosis.co.jp/en/our-story/company-profile/

Our Fecal Microbiota Transplantation Technology https://sym-biosis.co.jp/en/technologies/

Our NanoGAS® Technology https://sym-biosis.co.jp/en/technologies/

Patent Application Status https://sym-biosis.co.jp/en/technologies/

Intestinal flora transplants overseas https://fmt.sym-biosis.co.jp/en/about/

The usefulness of intestinal flora transplants and their history in Japan and abroad https://fmt.sym-biosis.co.jp/en/about/

Trends in clinical trials and clinical studies of FMT (Japan) https://fmt.sym-biosis.co.jp/en/about/

8-2. If you have any questions about Shinbiosis Coporation, please fill in your questions.

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms