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Download Forms

  • ・Medical Certificate Application   <sample>  *Japanese  language only
  • ・Travel Clinic Application
  • ・Request form for personal information disclosure  *Japanese  language only
  • ・Request to Reschedule Health Check-up
  • ・exercises considerations or restrictions 【身体運動・健康科学実習に関する情報提供書(体育用)】 ( For Students Enrolled in April and in the first semester of the Junior Division)  *Japanese  language only
  • ・Medical Information Provision Form (For PEAK Students)
  • ・Report form of health checkup abnormalities. (The Institute of Medical Science)
  • ・Report form of health checkup abnormalities. (The University of Tokyo Hospital)
  • ・Power of Attorney (For The University of Tokyo Health Service Center)
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  • 障害等のためにホームページが利用しにくい方へ
  • 日本語
  • About us
    • close
    • About
    • Our Activities
    • Services and charges
    • Clinical Research
    • Privacy and Compliance
  • Clinical Service
    • close
    • Clinical Service
    • Hongo Health Service Center
      • Internal Medicine
        • Travel Clinic
        • Vaccination Clinic
      • Psychiatry
        • Students
        • Staff
      • Dentistry
      • Ear, Nose, Throat
      • Gynecology
      • Radiology
    • Komaba Health Service Center
      • Internal Medicine
        • Travel Clinic
        • Vaccination Clinic
      • Psychiatry
        • Students
        • Staff
      • Dentistry
      • Orthopedics
      • Dermatology
      • Gynecology
      • Radiology
      • Health-Care Room
    • Kashiwa Health Service Center
      • Internal Medicine
        • Travel Clinic
        • Vaccination Clinic
      • Psychiatry
        • Students
        • Staff
      • Gynecology
  • Health Check-ups
    • close
    • Health Check-up for staff and faculties
      • Regular Health Check-up for staff and faculties
      • Health Check-up for those Engaged in Specified Work Content
      • Health Check-up for Newly Hired Employees
      • Health Check-up for Long Term Travelers
      • Health Check-up for Visiting Researchers
      • Health Check-up for Radioisotope (RI) Users
    • Health Check-up for students
      • Health Check-up for Newly Admitted Students
      • Group-I Students Health Check-up
      • Group-II Students Health Check-up (Spring)
      • Group-Ⅰ/Ⅱ Students Health Check-up (Autumn)
      • Health Check-up for PEAK Students
      • Health Check-up for teaching practice / care practice
    • Other Health Check-up
  • Check-up Report
    • close
    • Check-up Results (for Students)
    • Check-up Results (for faculty and staff)
    • Medical Certificates / Certificates of check-up results(For Students)
    • Medical Certificates(For Faculty and Staff)
  • Q&A・Others
    • close
    • Selected Q&A
    • Download Forms
    • System maintenance
    • Contact
    • Job information
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