Inquiries regarding immuno-cell therapy

Inquiries regarding immuno-cell therapy

For general inquiries regarding immuno-cell therapy please fill out the form below. We are not able to provide answers to specific questions regarding medical treatment and consultations. For such inquiries please contact the medical institution concerned directly.

Note:
*Please understand that it may take longer to respond to inquiries depending on their content and to inquiries received on a non-business day (weekends, national holidays, year-end and new-year holidays). Our response is sent to the person who made the inquiry. Any form of reproduction, dissemination and secondary use of the information provided without authorization is strictly prohibited.

*THIS FORMS IS SECURED BY SSL ENCRYPTION.

Name 必須 Given Name

Please enter 'Given Name'
Family Name

Please enter 'Family Name'
Address 必須 Street, Building name and room number

Please enter 'Street, Apartment'
City

Please enter 'City'
Prefecture/State

Please enter 'Prefecture / State'
Country

Please enter 'Country'
Postal Code

Please enter 'Postal Code'
Phone 必須

Please enter 'Phone'
Email address 必須

The confirmation email will be sent to this address, please make sure the information is correct.

Please enter 'E-mail Address'
'E-mail Address' is wrong
Inquiry content 任意
Image auth code 必須
Please enter 'Image auth code'reload
Please enter 'Image auth code'
'Image auth code' is wrong
Regarding to the use of the form:
The personal information you provide is protected in accordance with our Personal Information Protection Policy.
Personal Information Protection Policy