Inquiry form for our Patients at the Reproduction

•This form is exclusively for our existing patients at the Reproduction center. We cannot answer inquiries from new patients.
•For inquiries other than the following 1-4, please contact us by phone or ask your doctor at the time of consultation.
1. Availability of the Test results
2. Frozen samples: Request for Storage renewal or Disposal
3. Freezing results (only when you are told by your doctor)
4. Availability of the Ovarian tissue result: (Ovarian Dysfunction Clinic)
5. Inquiry on the Insemination result

Please note we are unable to respond to the following inquiries/requests by this form.

●Inquiries related to medical consultations such as medical conditions or treatment policies.

●Request to make, cancel, or reschedule appointments, or to check availability.

●Messages including your progress report to your doctor in charge.

●Questions and inquiries regarding your past visits.

・Depending on your inquiry, it may take some to reply. If you are in a hurry, please contact us by phone.

・Your personal information will be used only to respond to your inquiries.

Please fill out all the fields marked with ★.

Full name★

Hospital ID number★

Date of birth★

Email address★

A confirmation email will be sent to you upon receipt.
We recommend you to enter your PC address, as you may have a problem reading the long text or opening the attachment with a mobile email address.

Phone number★

Please give us the number that you can answer during the day.

Please select one from the following, fill in the required fields and send it. 【NOTE】 Please limit to 1 inquiry at a time. If you have multiple inquiries, please send us multiple forms.

inquiry★: 1. Availability of the Test results2. Frozen samples: Request for Storage renewal or Disposal3. Freezing results (only when you are told by your doctor)4. Availability of the Ovarian tissue result: (Ovarian Dysfunction Clinic)5. Inquiry on the Insemination result

Please fill in the details below only for the item selected above.

1. Availability of the Test results: Test date
Item (select all that apply)Blood testEndometrial testChromosome testOthers (specify in the box below)
Others (specify in the box below)
Our reply will be limited only to whether or not the test result is available.
We cannot give you the test results by email. If they aren’t ready yet, please contact us again after a while.

2. Storage of Frozen samples: Renewal or Disposal request: Select oneRenewal requestDisposal requestRenewal and Disposal request
Please send us your street address so that we can send the documents by post.
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3. Freezing results(only when you are told by your doctor): Egg retrieval (OPU) date
Doctor in charge (doctor’s name)
Your doctor in charge will inform you of the freezing result.

4. Availability of the Ovarian tissue result: Ovarian Dysfunction Specialty Clinic: Surgery date
It takes about 1 to 3 months to get the result.
Our reply will be limited only to whether or not the test result is available.
We cannot give you the test results by email. If they aren’t ready yet, please contact us again after a while.

5. Inquiry on the Insemination result: Egg retrieval (OPU) date
Insemination results will be given the next day ONLY IF you request the result on the day of egg retrieval (ER).
If you request the result after the day of ER, please note it will take several days to report.

About protection of personal information

The personal information provided will be used to provide information related to the hospital.
This form uses SSL and encrypts the data transmitted.

A copy will be sent to the email address you provided. In case you do not receive the copy, please contact us by phone as the address you entered may be incorrect, so.