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Reservation form

    ▶︎Number of Visits

    ▶︎Your name (Pseudonym is OK) *

    ▶︎Email address*

    *Please re-enter for confirmation

    ▶︎Preferred course*

    ▶︎Preferred Staff*

    →staff schedule

    ▶︎Desired Date*

    ▶︎Desired Time

    First choice*

    Second choice*

    ▶︎Treatment Room

    ▶︎Questions/Requests etc. (In the case of a home/hotel service, please write the hotel name, the nearest station and your home address.)


    *Required Field