Questionnaire for Online Consultation

 
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cm
kg
If you have been infected more than once, please tell us the time of your last infection. 一回以上感染したことがある場合は最後に感染した時期を教えてください。
times 回
mins. 分
If a retest is necessary, you may be asked to come to the OIST parking lot to be retested. 再検査が必要な場合は、OISTの駐車場まで来てもらって再検査します。
Please attach a jpeg document.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.
Please attach a jpeg document of your positive result.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.