Inquiries about moving in

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Please fill in the form below and click the "Go to input confirmation screen" button to confirm the content before sending.
The person in charge will contact you within a few days.If you are in a hurry, please contact us by phone (0887-55-2888).

About those who make inquiries

Those who make inquiries
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name
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Request

About those who move in

Name
name
Address
TEL
FAX
E-mail Address
Area of ​​your choice
Facility of your choice
Facilities in Kochi Prefecture:
Facilities outside Kochi Prefecture:
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age
age
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If you have any services or hospitals you are currently using, please fill them out.

Please provide personal information in order to provide information on the use and services of this corporation.
The personal information you provide will be managed and used legally, appropriately and safely within the scope necessary to achieve your request.
In addition, the personal information provided will not be provided to a third party without consent.
If you agree with the above items, please contact us using the input form.
At the time of making an inquiry, we assume that you have agreed to the handling of personal information of this corporation.