Request a Medical Appointment

Request an Appointment
AT BLEZ CLINIC ASOKE

Welcome to the ASOKE Branch of BLEZ Clinic.

We offer fast and friendly care in English, Japanese, and Thai.

▼ Skip directly to the Appointment Form

Prefer to Book via LINE?

Book via LINE

Please add our official LINE account before contacting us.

📞 Urgent inquiries: 092-224-6972 (English/Thai/Japanese support)

    ■Purpose of Inquiry *Required

    ■Clinic Visit *Required

    ■Desired Services (Multiple selection possible)

    ■1st Preferred Date and Time (e.g., July 10, Morning)

    ■2nd Preferred Date and Time (e.g., July 12, Afternoon)

    ■Name (As shown in Passport) *Required

    ■Email Address *Required

    If you wish to be contacted via LINE, please register our official LINE account.

    Click here for Asoke Branch LINE

    ■Phone Number (Optional)

    ■Questions or Requests (Optional)

    *Please enter your 3rd preferred date and time here if applicable.

    *A confirmation screen will not be displayed. Please check your entries and click the submit button.

    I have confirmed the contents.