Nomura Securities Co.,Ltd. Medical Examination Application
(Specific Medical Checkup for Late-Night Workers)

You are able to make a reservation for our Medical Examination via web site.
Please complete the form below and press the CONFIRM button to jump to the next page.
Your reservation is not confirmed at this time.

    Name *

    First Name

    Last Name

    Gender *

    Birthday *

    • year

    • month

    • day

    Department Name *

    Address *

    • Zip code *

    • Address 1 *

    • Address 2

    • Address 3

    Phone Number *

    E-mail address *

    • Re-enter the same e-mail address

    Available Date *

    • Please choose three days schedule your convenience.
      Reservation time is between 14:00 and 15:00 from Monday to Friday.
      Your reservation time will be announced when your reservation has been confirmed.

    • 1st Available Date:

    • 2nd Available Date:

    • 3rd Available Date:

    Privacy Policy

    Sakakibara Sapia Tower Clinic hereby establishes the following stipulations pertaining to the handling of private information in the possession of Sakakibara Sapia Tower Clinic, based upon Japan’s Private Information Protection Law and related laws and ordinances, the guidelines and policies determined by Japanese government ministries pertaining to these said laws and ordinances, and private information protection management rules and other designations determined by Sakakibara Sapia Tower Clinic

    1. Private Information Use Purposes
    Private information acquired by Sakakibara Sapia Tower Clinic shall be used for the purpose of reservation and contact for medical checkup.

    2. Private Information Inquiries Desk
    If there are any questions regarding this privacy policy you may contact us using the information below.

    Sakakibara Sapia Tower Clinic
    Address: Sapia Tower 7F, 1-7-12 Marunouchi, Chiyoda-ku, Tokyo, Japan

    (c) Sakakibara Sapia Tower Clinic. All Rights Reserved.