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Physical Exam Application and Questionnaire Form for students is no longer paper!


Health care physicals


The Health Care Center is introducing an online registration system for student physical examinations from April. In place of the previous paper-based application form, students will be required to complete an online application and questionnaire form on the Health Care Center's web site. Completion of the application and questionnaire form must be done at least one day before your checkup. Application can be made at the Health Care Center web site starting Monday, April 2, 2012.

Log in to your account on the Health Care Center's web site using your personal ID.

After selecting your gender, your year in school, and the checkup date of your choice, enter your email address and phone number. Finally, complete the questionnaire about your current health.

Please note: You must complete the online form no later than 12:00 noon on the day before your checkup. If you do not do this, you will not be able to take the required physical exam.

How much time does this involve? About 3 ~ 5 minutes... Why not fill it out now?

Questions or more information? Contact: AKASHI or SHIRANE, staff members at the Health Care Center

Tel: 06-6879-4159

Email: checkup-info[at]

(When using the email address, please replace [at] with @.)

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