Home Test Order Page
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Family Name        First Name *
Address *
Kit can be shipped anywhere in Japan but not overseas.
Post Code
Apartment Building Name and Room Number *
If your residence is not an apartment, please write it is a house in this section
Japanese Mobile Number *
If you have no number, please write no number and go to the next question
LINE, Skype or WhatsApp ID
Please write your number/ID here if you have no Japanese Mobile Number
Email *
Gender *
Information on pricing
Japanese Insurance does not cover STD tests with no symptoms. Home testing kits can be slightly cheaper because they don’t include doctor fees.
Test Kit to order (Tax included) *
Preferred Delivery Date
Delivery date and time can be selected for HIV, Syphilis, Chlamydia, Gonorrhea, Candida and Trichomoniasis Kit. Other Kits will be delivered in your mail box at the earliest deliverable date.
Preferred Delivery Time
For  HIV, Syphilis, Chlamydia, Gonorrhea, Candida and Trichomoniasis Kit only.
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This form was created inside of Japan Healthcare Info.