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Intake Forms

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General Care Intake Forms

Printable Intake Forms


Here you can download and print First Visit forms to take with you to the doctor.

These forms come directly from the Ministry of Health, Labour, and Welfare. Even if your clinic insists on you using their proprietary form, you can still print out a form from the list below and use it as a reference guide.

All of the forms are bilingual in Japanese and English, Chinese, Portuguese, or Spanish. Unfortunately, the MHLW does not provide these forms in any other languages at this time.

Please select the type of doctor you are planning to visit from the list below and print the form you need.

Cardiology (heart)


Dermatology (skin)

Gastroenterology (digestive)

Internal medicine

Obstetrics and Gynecology (maternity & female reproductive system)

Ophthalmology (eyes)

Orthopedics (musculoskeletal)

Otorhinolaryngology (ENT)

Pediatrics (children under 15)

Psychiatry (mental health)

Pulmonology (lungs)

Urology (urinary)

Surgery Intake Forms

Cardiac Surgery (heart surgery)

General Surgery

Neurosurgery (brain surgery)


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