Appointment at Musashi Eye Clinic, MEC
Please submit only one request per issue. After submitting your request, you should quickly receive an auto-reply confirming that you have sent your request. Once we receive your request, our staff will soon contact you by phone to review your medical, financial information, and insurance coverage before an appointment may be offered.
If you didn't receive auto-reply e-mail, please check your e-mail address and send your inquiry again.
Please call 119, if you are having a medical emergency. The ER team will care for you or your family.
Musashi Eye Clinic, MEC, Kaminoge Station
Eye care for children and adults
Who is this appointment for?
Please provide patient information. All fields are required unless marked optional.
Have you previously received care at our clinic?
No (First visit)
Legal first name
Legal middle name (optional)
Legal last name
Patient ID number at MEC (optional)
Present address in Japan
Primary phone number
Secondary phone number (optional)
Prefer not to say
Age (Pull-down menu)
0-3 years old
4-10 years old
11-19 years old
20-29 years old
30-39 years old
40-49 years old
50-59 years old
60-69 years old
70-79 years old
80-89 years old
90-99 years old
over 100 years old
Please select the date you prefer to visit.
(Year/Month/Day) Office is closed on Wednesday, Sunday, and Holidays.
Please select the time you prefer to visit. [First choice]
Pull-down menu (Note: On Saturday, reception is closed at 12:00)
Please select the time you prefer to visit. [2nd choice]
Pull-down menu.（Note: On Saturday, reception is closed at 12:00）
Medical concern (primary)
（Multiple answers allowed）
General eye care
Strabismus and Amblyopia
Are there additional medical problems the patient needs assessed during this visit? (optional)
Please check your request again and click once if you have confirmed it. Your request will be sent when you click the blue box, "送信" .
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