Tokyo/Ogikubo | Maple Acupuncture & Moxibustion Clinic

Reservation Form

Please fill out the below and click "Check your entries".

* Name
* E-Mail
* Phone
- -
* Preferred Course
Preferred date and time
The 1st Choice (Compulsory Input)
The 2nd Choice
The 3rd Choice
Any questions and/or requests
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