Name of your organization
For questions from an individual, please indicate “individual person.”
Department name, title, etc.
Your name Example: Taro Syskan
Phone No. Use half-size figures for entry
Fax No. Use half-size figures for entry
E-mail address Use half-size characters
Address -

Example: 1-7-2 Hacchobori, Chuo-ward, Tokyo

Example: 2nd Floor, Nagaoka No. 2 Building
Details of question
If possible, please indicate the present problems of your hospital, if any.

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