Page 1 of 8

Appointment Request · Keio University Center for Preventive Medicine

Prototype. Built by Queen & Co. to show how the English request form could work. It is not connected to the center's booking system and nobody at the center sees what you enter here. Please use made-up details.
This takes about three minutes. When you send it, you get a confirmation email with a reference number straight away. The center's international team then replies with the dates available, and your booking is confirmed when you receive their confirmation email.

Where do you live?

A
B

Which language should we use with you? For email and on the day of your visit.

A
B
C
D