PCL Zaide Booking Form

Thank you for your interest in our services!

You’re just one step away from securing your appointment with us. To proceed, please fill out the booking form below.

online forms

Booking Form

If you want to book your appointment, please complete this form.

Appointment Date

Preferred Date 1

Preferred Time 1

Preferred Date 2

Preferred Time 2

Preferred Date 3

Preferred Time 3

Personal Information

Date of Birth

Gender

Exclusive Privileges

Note: Meals are not included in the Japanese Standard Health Checkup package. Click here to see the meal descriptions.

Payment Method

Upload Membership Card

Others

Is this your first time visiting our diagnostic center or are you a returning patient?

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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.