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Download Forms

  • ・Medical Certificate Application   <sample>  *Japanese only
  • ・Travel Clinic Application <sample>
  • ・Request form for personal information disclosure
  • ・Request to Reschedule Medical Check-up
  • ・Special Care Required when Attending University 【就学に関する情報提供書】(Student for Enrolled in April and in the first semester of the Junior Division)  *Japanese only
  • ・Special Care Required when Attending University
  • ・Report form of medical checkup abnormalities. (Students)
  • ・Report form of medical checkup abnormalities. (staff)
  • ・Report form of medical checkup abnormalities. (The Institute of Medical Science)
  • ・Report form of medical checkup abnormalities. (The University of Tokyo Hospital)

 

・For vaccine questionnaires, click here (Japanese language only.)

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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
      • Psychiatry
        • Students
        • Staff
      • Dentistry
      • Ear, Nose, Throat
      • Radiology
    • Komaba Health Service Center
      • Internal Medicine
        • Travel Clinic
      • Psychiatry
        • Students
        • Staff
      • Dentistry
      • Orthopedics
      • Dermatology
      • Radiology
      • Health-Care Room
    • Kashiwa Health Service Center
      • Internal Medicine
        • Travel Clinic
      • Psychiatry
        • Students
        • Staff
  • Medical Check-ups
    • close
    • Medical Check-ups
    • Checkup for Newly Admitted
    • Yearly Checkup for Students I & II
    • Check-ups for PEAK Students
    • Medical Check-ups for Autumn Entry Students and Researchers
    • Medical checkup for teaching practice / care practice
    • Regular Medical Check-up for staff and faculties
    • Medical Examination for Those Engaged in Specified Work Content
    • Health Check-up for Newly Hired Employees
    • Check-ups for Long term Travelers
    • Medical Check-up for Radioisotope (RI) Users
    • Visiting Researchers Checkup
  • Checkup report
    • close
    • Students
    • 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
    • Contact
    • Job information
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