Appointment Requests | Sakura Platinum Dental Clinic(Shibuya)
【🗓️Confirmed = Booked】
Your appointment is confirmed once you receive a「Confirmation」email (not the auto-reply).

Note : 
・For any inquiries or replies, please use "sakurashika20170301+en@gmail.com".
・You will receive an automatic reply after submitting the form, but please note that replies to it will not be read.
・ A confirmation email will follow within 48 hours.If not, check your spam folder and allow emails from "sakurashika20170301+en@gmail.com".
・If you don't hear from us within 48 hours, please call +81-3-6452-6588.
・For cancellations or changes after confirmation, check our policy:  cancellation policy

【🗓️Same-Day May Be Unavailable】

Same-day bookings are often unavailable.
Even if you prefer today, include 2 other dates when sending your 3 options.

LANGUAGE SUPPORT
We use a translation app to assist non-Japanese speakers.

↓First, the field labeled "メールアドレス", Please enter your regular "email address". Confirmation emails will be sent there.

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Email *
e-mail (again for confirmation) *
To avoid typos, enter the same email again.
Your Full Name *
【Choose the 3 preferred dates & time zones 】
●(1/3) 1st choice date *
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DD
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YYYY
●(1/3) 1st choice time zone(multiple choices possible) *
★(2/3) 2nd choice date *
MM
/
DD
/
YYYY
★(2/3) 2nd choice time zone(multiple choices possible) *
■(3/3) 3rd choice date *
MM
/
DD
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YYYY
■(3/3) 3rd choice time zone(multiple choices possible) *
Telephone number
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Please select your symptoms(Choose one or more) or the treatment you require. *
Required
Comments section
Please let us know if you have any comments or requests.
※Regarding the Privacy Policy *
For more details about our Privacy Policy, click here:

https://www.sakurashika24-3.com/en/policy

※ Please select "I agree" when submitting the form.

After filling out the form, please be sure to click the "送信" button below.
【Sakura Platinum Dental Clinic (Shibuya, Tokyo) 】
CLINIC LOCATION
Sakura Platinum Dental Clinic
5th & 6th Floor, Shibuya Higashi-guchi Miami Building
2-22-13 Shibuya, Shibuya-ku, Tokyo 150-0002
・1 min. walk from Shibuya Station
・Our dental office is on the 5th and 6th floors of the building next to Shibuya Hikarie, with the takoyaki shop “GINDACO” on the 1st floor.

PLEASE BRING WITH YOU
-A valid photo ID
-A credit card or cash for payment
-Travel insurance information, if applicable

TREATMENT FEES & SERVICES
You can view our service menu and prices here:
-Services & Fees


Note: For smoother communication, please contact us online, as English support may be limited.

【CONTACT US】
For any inquiries or replies, please use "sakurashika20170301+en@gmail.com".
Auto-replies are sent from the no-reply address. but please use "sakurashika20170301+en@gmail.com" for all communication.

We look forward to welcoming you to our clinic.
A copy of your responses will be emailed to the address you provided.
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