About the medical questionnaire (colorectal cancer screening, tuberculosis screening, electrocardiogram test, renal function test, uric acid test, hepatitis virus screening)
Update date: March 30, 2023
For those undergoing colon cancer screening, tuberculosis screening, electrocardiogram, kidney function test, uric acid test, or hepatitis virus screening
- A medical questionnaire is required for the above consultations. Please fill out the medical questionnaire in advance and bring it with you to the medical institution.
- The medical questionnaires are available at the City Hall Main Building 2F (Life and Welfare Division), Hirao/Wakabadai Branch Office, and the Health Center. You can also download them here.
Note: There are 2 medical questionnaires. Please fill out both forms and bring them to your medical institution.
Questionnaire (front) (PDF: 116KB)
Medical questionnaire (back side) (PDF: 125KB)
Click here for details on colorectal cancer screening<br id="3"/> Click here for details on tuberculosis screening, electrocardiogram, renal function test, and uric acid test<br id="6"/>Details on hepatitis virus screening Click here
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Inquiries regarding this page
Inagi City Welfare Department Health Division
112-1 Hyakumura, Inagi City, Tokyo (Inside Inagi City Health Center)
Phone: 042-378-3421 Fax: 042-377-4944
