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The application form from this

Application form

On having you apply

  • You read "a privacy policy" on an inquiry about application and the application and apply after an agreement, and please refer.
  • The inquiry about the application may take time for an answer. The dispatch, please feel free to contact us over a telephone.
Medical corporation Fukuji fortune surgery hospital TEL: 073-488-1339

About the input is careful

  1. ※The seal is a required item. Please input by all means.
  2. Please input all the katakana with full size.
  3. Please input a phone number (home or cell-phone) to get of the communication into a phone number column by all means.
  4. If input is over, please click "the contents confirmation" under the form.
  5. As contents confirmation screen opens, after confirming input contents, I click "the transmission" and am completion.

Inquiry

The name ※required
※An example: Taro Yamada
Furigana ※required
※An example: Yamada Taro
Zip code
※An example: 123-4567
The metropolis and districts
Municipality
Address, name
Phone number
E-mail address ※required



Only as for note) half size alphanumeric character
The type of job desired ※required
Desired motive and appeal point / inquiry contents
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Medical corporation Fukuji fortune surgery hospital
〒641-0021
Wakaurahigashi, Wakayama-shi, Wakayama
3-5-31
TEL. 073-445-3101
FAX. 073-445-4660
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