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Saitoh Dental Office Koenji 　IK Bdg.2F　3-10-5 Koenjikita, Suginami-ku, Tokyo, Japan	TEL 03-3223-4182 6 minutes walk from the north exit of Koenji Station on the JR Chuo Line 　At the western end of Koenji Kitanaka Shopping Street

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Treatment guide 　　Dentistry 　　Periodontal disease 　　Pediatric dentistry 　　Orthodontics 　　Oral surgery

To have a medical examination for the first time 　For you can be examined for the first time at our hospital, the current medical condition and medical history (chronic condition or major illness in the past) 　In order to understand such things, we ask you to fill out a questionnaire. 　If you download the questionnaire from the following in advance so that you can shorten the waiting time at our hospital, 　You can fill out the questionnaire at home. 　→ Download the questionnaire 　What to bring on the day of your first visit ・ Filled out questionnaire ・ Health insurance card ・ Instructions given at the medicine notebook or pharmacy (for those taking medication) ・ Mother and Child Handbook (pregnant / infant) 　If you have any questions, please do not hesitate to contact us. 　How to use 1. "Download the questionnaire" 　Please click. 　(A new page will open in PDF) * To open a PDF file 　Adobe Reader is required. 　Adobe Reader opens the → Here 　You can download it from. 2. Please print (A4 size). 3. Please fill in the required parts 　(It's fine as far as you can). Small caries ｜ Middle caries ｜ Large caries 1 Pulpectomy ｜ Large caries 2 Infected root canal ｜ Post-treatment Prosthodontics ｜ Tooth extraction ｜ Periodontal disease ｜ Brush teeth at home ｜ Brush teeth in clinic IK Building 2F 3-10-5 Koenjikita, Suginami-ku, Tokyo, Japan TEL: 03 (3223) 4182 Copyright (C) 2014 Saitoh Dental Office Koenji. All Rights Reserved.