Registration form for AUS visa health examination

Please make an appointment with us over the phone before submitting.

* Mandatory fields

渡航国 Health case country


健診受診日 Exam date *

 Y   M   D   

予約時間 Reserved time *

名前(ローマ字) Name *

Name as in passport


性別 Gender *

生年月日 DOB *

 Y   M   D

年齢 Age *


住所 Address *

Postal Code  -    Find zip code

日中の連絡先電話番号 Contact telephone number *

e-mail アドレス e-mail address *

健診用個人ID Health case ID type *


パスポート情報 Passport details *

Passport No.

Issuing country

Date of issue
 Y   M   D

Date of expiry
 Y   M   D

ビザの種類 Visa category & type *

必要な検査項目 Required certificates *

Type of Medical Certificate Fee (excluding tax) Object person Time Required
¥25,000 11yrs and above 1hr - 2hrs
¥13,000 11yrs and above 30min -1hr
¥18,000 5yrs and above 30min -1hr
¥10,000 Under 5yrs
¥5,000 Permanent visa, applicants engaged service in medical service 2hrs - 3 hrs for applicants having blood tests
¥2,500 Applicants engaged in medical service, Pregnant women
¥2,500 Applicants engaged in medical service