*Please fill in the information below, it will help us to have a smooth consultation. 아래 정보를 기입해주시면, 원활한 상담에 도움이 됩니다.

1. Name 名前 | 姓名 성함 

   Last Name (Surname) 姓 -   

   First Name (Given Name) 名 - 

2. Gender / Date of Birth 性別/生年月日 | 性别/出生日期 성별/생년월일

:

3. Nationality 国籍 | 国籍 국적 

:

4. Email address Eメール | 电子邮件 이메일

:

5. Phone number 電話番号 | 电话号码 전화번호

:

6. Language 使用言語 | 使用语言 사용언어

:

7. Preferred date of appointment (please include the length of your stay in Korea) 

希望の予約日時(韓国滞在期間も一緒に記載) | 预约希望日期(请同时注明在韩国的停留期限)

예약희망일 (한국체류기간도 함께 기재)

:

8. Number of visitors 来院予定人数 | 预计到访人数 내원 예정인원

:

9. Concerns (procedure you are interested in) 

ご希望の施術(肌悩みなど) | 困扰内容(感兴趣的治疗项目) 

고민내용 (관심있는 시술)

:

** Having trouble submitting?

- Please fill in your name, password, subject and inquiry above.

- Please click the button 'submit' on the top right to complete your reservation.

If it still doesn’t work, feel free to email us at lamineclinic@naver.com..

** All posts on the board are private, so be sure to enter a password when submitting. The password is required to view posts, so make sure you don't forget it.