Exciting Rewards Await for Your Referrals!

Share the gift of good health to your loved one.

To proceed with your referral, please fill out the referral form below.

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Patient Referral Form

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Name

Age:

Promo Code:

Contact Number:

Treatment Interested In:

Checkup Date

Referral's Membership Number:

Number: Interested Membership

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Exclusive Complimentary Meals

Karaage Bento
White rice, chicken karaage, rolled omelette, potato and carrot salad

Vegetarian Bento
White rice with seaweed, tofu and vegetable patty, black seaweed and carrot salad, spinach

Inarizushi Bento
Salad maki sushi and shrimp ikura inari sushi

REMINDER:
Meals may contain potato, sake, mirin, soy, dashi, kelp, sesame, carrots, mushrooms, ham, carrots, cucumber, hijiki, cabbage, vinegar, egg sugar, salt, lotus root, and chicken. Please inform us in advance if you have any food allergies, intolerances, or special dietary needs. Your health and safety are important to us, and we will do our best to accommodate your request.

Note: The meal options provided on the day of your appointment are subject to change based on availability. For VIP Shinagawa Dock patients, the meals will only be served on the first day of your health checkup.