Questionnaire (Colorectal Cancer Screening, Tuberculosis Screening, Electrocardiogram Test, Kidney Function Test, Uric Acid Test, Hepatitis Virus Screening)

For those undergoing colorectal cancer screening, tuberculosis screening, electrocardiogram testing, kidney function testing, uric acid testing, and hepatitis virus screening

• A questionnaire is required for the above examination. Please fill out the questionnaire in advance and bring it to the medical institution.
• The medical questionnaire is available at the City Hall main building 2nd floor (Livelihood Welfare Division), Hirao and Wakabadai Branch Offices, and the Health Center, so please use it. It is also possible to download from the following attached file.

Note: There are two medical questionnaires. Please fill out both and bring them to the medical institution.

• Questionnaire (Front) (PDF 116.1KB)
• Medical Questionnaire (Back) (PDF 125.1KB)

For details about colorectal cancer screening, please see the following page.

• Fiscal Year 2024: Colorectal Cancer Screening: Target Group 40 Years and Older

For details on tuberculosis screening, electrocardiogram tests, kidney function tests, and uric acid tests, please see the following page.

• Fiscal Year 2024 Tuberculosis Screening (X-ray)・Electrocardiogram Test・Kidney Function Test・Uric Acid Test: Target Group 40 Years and Older

For details about hepatitis virus screening, please see the following page.

• Fiscal Year 2024 Hepatitis Virus Screening: Target Group 40 Years and Older