* Please enter your mobile phone number and e-mail address correctly, otherwise we can't contact you.
name
country
mobile phone number
(including your country code).
* To confirm your reservation, we will contact your mobile phone. Your mobile phone number is essential.
re-type
mobile phone number
e-mail
Your e-mail address will be used as the password
on 'Reservation List' page.
re-type
e-mail
Name of Treatment
consultation date    Click here to set your consultation date.
surgery date   Click here to set your surgery date.
I will decide the operation date after the consultation.


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