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お問い合わせ・無料治療相談

-下記のお悩み以外のことでも、歯科で解決することがあります。どうぞお気軽にご相談ください。-
舌の後退 | 食いしばり | 歯ぎしり | 無呼吸 症候群 | インプラント治療| 歯周病治療 | 歯の破折 | ブリッジ脱離 |　顎関節症 | 虫歯治療 |親知らず（智歯抜歯） |入れ歯（義歯） | ホワイトニング　｜　ヒールオゾン　| 姿勢咬合 | 金属アレルギー | ジルコニアインプラント | ジルコニア | 皮膚科 | ジルコニアクラウン |ジルコニアインレー | セラミッククラウン | ノンメタル治療 | 保険の効かない入れ歯 | 足育 | 食育 | 医療費控除 | 歯周外科 | 歯周病評価 | 歯周病管理 | 口腔内管理 | 歯周病専門医 | 治療評価 | 口腔内写真 | スリープスプリント | 口呼吸 | 鼻呼吸 | 口いびき | 鼻いびき | 耳鳴り | 難聴

お問い合わせの前にご確認ください。
▶ よくある質問

お急ぎの方はまずはお電話（ 025-250-7662）で、 予約状況によっては即日ご相談できますので、お気軽にお問い合わせください。

「インプラントは初めてだから心配…」という方、まずは無料相談をお勧めします。 ご希望の方は下記の注意書きをご確認下さい。

• 無料相談をご希望の方は、下記フォームにご記入の上、送信してください。
• ご予約は当院から折り返しお電話をかけさせていただき、ご確認がとれましたら完了となります。 送信いただくだけでは予約は完了しておりませんので、ご理解いただきますようよろしくお願いいたします。
• 原則として48時間以内にご連絡させて頂きます。（月曜・日曜・祝日を除く）
• 診療時間外（土曜日18時以降・日曜日・月曜日・祝日）のお問い合せの場合は、ご予約確認が火曜日以降となります。

※は必須項目となります。

ご希望のお問い合わせ内容

無料相談
その他お問い合わせ/メール無料相談

お名前 ※

ふりがな ※

年代

20代 30代 40代 50代
60代 70代 80代以上

メールアドレス ※

PCでお使いになれるアドレスを入力してください
※メールアドレスの記入のお間違いが多くなっています、再度ご確認下さい。

携帯電話番号 ※

お手数ですが、お使いのお電話に[025-250-7662]から着信がございましたらご連絡くださいますようお願い申し上げます。

無料相談希望日 ※

希望する日と時間帯を第3希望までお選び下さい。
土曜日は非常に込み合っております。 平日の方が比較的スムーズにご案内可能ですのでお急ぎの方はご検討下さい。

第1希望

-希望日- 20261027 20261028 20261029 20261030 20261103 20261104 20261105 20261106 20261110 20261111 20261112 20261113 20261117 20261118 20261119 20261120 20261124 20261125 20261126 20261127 20261201 20261202 20261203 20261204 20261208 20261209 20261210 20261211 20261215 20261216 20261217 20261218 20261222 20261223 20261224 20261225

の

-時間帯- 10:00-14:00 14:00-18:00

第2希望

-希望日- 20261027 20261028 20261029 20261030 20261103 20261104 20261105 20261106 20261110 20261111 20261112 20261113 20261117 20261118 20261119 20261120 20261124 20261125 20261126 20261127 20261201 20261202 20261203 20261204 20261208 20261209 20261210 20261211 20261215 20261216 20261217 20261218 20261222 20261223 20261224 20261225

の

-時間帯- 10:00-14:00 14:00-18:00

第3希望

-希望日- 20261027 20261028 20261029 20261030 20261103 20261104 20261105 20261106 20261110 20261111 20261112 20261113 20261117 20261118 20261119 20261120 20261124 20261125 20261126 20261127 20261201 20261202 20261203 20261204 20261208 20261209 20261210 20261211 20261215 20261216 20261217 20261218 20261222 20261223 20261224 20261225

の

-時間帯- 10:00-14:00 14:00-18:00

その他・備考 ※

ご予約確認のご連絡をお電話にて差し上げますので、ご都合のよい時間帯をご記入下さい。
★当院からの「ご予約確定のお知らせ」をもってご予約の確定とさせて頂きます。

今までの病歴について、該当するものをチェックして下さい。(複数選択可)

心臓病 肝臓病 高血圧 骨粗鬆症
悪性新生物（ガン） 感染症

脳神経系
消化器系 その他

喫煙の習慣

ある ない 以前はあったが今はない

送信する

Thank you!

お問い合わせを受け付けました。
後ほどのお返事をお待ちください。

予約の日時の確定は、お電話にてご連絡させていただきます。

・原則として48時間以内にご連絡させて頂きます。
（月曜・日曜・祝日を除く）
・診療時間外（土曜日18時以降・日曜日・月曜日・祝日）の
お問い合せの場合は、ご予約確認が火曜日以降となります。