{"id":401,"date":"2020-03-17T16:13:14","date_gmt":"2020-03-17T07:13:14","guid":{"rendered":"https:\/\/www.nmct.ntt-east.co.jp\/en\/?page_id=401"},"modified":"2025-02-06T16:05:27","modified_gmt":"2025-02-06T07:05:27","slug":"contactus","status":"publish","type":"page","link":"https:\/\/www.nmct.ntt-east.co.jp\/en\/contactus\/","title":{"rendered":"Inquiry form"},"content":{"rendered":"<div class=\"main_contents\">\n<\/p>\n<div class=\"main_section inquiry inputform\">\n<h1 class=\"first\">Inquiry form<\/h1>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1417-o1\" lang=\"ja\" dir=\"ltr\" data-wpcf7-id=\"1417\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/401#wpcf7-f1417-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1417\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1417-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"input_only\">\n\t<p class=\"lead\">Please submit inquiries regarding our hospital using the form below.<br>\n\tAppointments or medical consultations that fall under individual medical practice cannot be made through the inquiry form.<br>\n\tAppointments can be made by telephone.<br>\n\tFor general inquiries, please click <a href=\"\/en\/faq\/\">here<\/a>.<br>\n\t<strong>*<\/strong>Indicates a required field.<\/p>\n\t\n\t<\/div>\n\t<dl class=\"must\">\n\t\t <dt>Your Name <strong>\u203b<\/strong><\/dt>\n\t\t <dd><span class=\"wpcf7-form-control-wrap\" data-name=\"your_name\"><input size=\"40\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"ex:\uff1aTaro Kanto\" value=\"\" type=\"text\" name=\"your_name\" \/><\/span><\/dd>\n\t<\/dl>\n\t<dl class=\"must\">\n\t\t <dt>Your Date of Birth <strong>\u203b<\/strong><\/dt>\n\t\t <dd class=\"sum_error\">Date <span class=\"wpcf7-form-control-wrap\" data-name=\"birth_d\"><input size=\"40\" maxlength=\"2\" minlength=\"2\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required w15p\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"01\" value=\"\" type=\"text\" name=\"birth_d\" \/><\/span><span class=\"ml10\">Month <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"birth_m\"><input size=\"40\" maxlength=\"2\" minlength=\"2\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required w15p\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"01\" value=\"\" type=\"text\" name=\"birth_m\" \/><\/span><span class=\"ml10\">Year <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"birth_y\"><input size=\"40\" maxlength=\"4\" minlength=\"4\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required w20p\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"1990\" value=\"\" type=\"text\" name=\"birth_y\" \/><\/span><br>\n\t\t <span class=\"error_message\">\u5165\u529b\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/dd>\n\t<\/dl>\n\t<dl class=\"must\">\n\t\t<dt>Gender <strong>\u203b<\/strong><\/dt>\n\t\t<dd><span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"gender\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"gender\" value=\"Male\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"gender\" value=\"Nonbinary\" \/><span class=\"wpcf7-list-item-label\">Nonbinary<\/span><\/label><\/span><\/span><\/span><\/dd>\n\t<\/dl>\n\t<dl class=\"must\">\n\t\t <dt>E-mail Address <strong>\u203b<\/strong><\/dt>\n\t\t <dd><span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"ex\uff1akanto@east.ntt.co.jp\" value=\"\" type=\"email\" name=\"email\" \/><\/span><\/dd>\n\t<\/dl>\n\t<dl class=\"must\">\n\t\t <dt>Phone Number <strong>\u203b<\/strong><\/dt>\n\t\t <dd class=\"sum_error\"><span class=\"wpcf7-form-control-wrap\" data-name=\"tel_a\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required w15p\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"text\" name=\"tel_a\" \/><\/span><span> - <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"tel_b\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required w15p\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tel_b\" \/><\/span><span> - <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"tel_c\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required w15p\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tel_c\" \/><\/span><br>\n \t\t <span class=\"error_message\">\u672a\u5165\u529b\u3067\u3059<\/span><\/dd>\n\t<\/dl>\n\t<dl class=\"must\">\n\t\t <dt>Country <strong>\u203b<\/strong><\/dt>\n\t\t <dd><span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><input size=\"40\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"country\" \/><\/span><\/dd>\n\t<\/dl>\n\t<dl class=\"must\">\n\t\t <dt><label for=\"request_item\">Category<\/label>\u00a0<strong>\u203b<\/strong><\/dt>\n\t\t <dd><span class=\"wpcf7-form-control-wrap\" data-name=\"request_item\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"request_item\" value=\"Outpatient\" \/><span class=\"wpcf7-list-item-label\">Outpatient<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"request_item\" value=\"Hospitalization\" \/><span class=\"wpcf7-list-item-label\">Hospitalization<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"request_item\" value=\"Recruit\" \/><span class=\"wpcf7-list-item-label\">Recruit<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"request_item\" value=\"other\" \/><span class=\"wpcf7-list-item-label\">other<\/span><\/label><\/span><\/span><\/span><\/dd>\n\t<\/dl>\n\t\n\t<dl class=\"must\">\n\t\t <dt>Message<strong>\u203b<\/strong><\/dt>\n\t\t <dd><span class=\"wpcf7-form-control-wrap\" data-name=\"request_detail\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Please enter your message within 2,000 characters.\" name=\"request_detail\"><\/textarea><\/span><\/dd>\n\t<\/dl>\n\t<p class=\"note\">For information about management of personal information, please refer to our <a class=\"link_blank\" href=\"https:\/\/stg.nmct.ntt-east.co.jp\/en\/privacypolicy\/\" target=\"_blank\" rel=\"noopener noreferrer\">Privacy Policy.<\/a><\/p>\n\t\n\t<div class=\"submit\"><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/><\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Inquiry form<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":37,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-401","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.nmct.ntt-east.co.jp\/en\/wp-json\/wp\/v2\/pages\/401","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nmct.ntt-east.co.jp\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.nmct.ntt-east.co.jp\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.nmct.ntt-east.co.jp\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nmct.ntt-east.co.jp\/en\/wp-json\/wp\/v2\/comments?post=401"}],"version-history":[{"count":5,"href":"https:\/\/www.nmct.ntt-east.co.jp\/en\/wp-json\/wp\/v2\/pages\/401\/revisions"}],"predecessor-version":[{"id":1447,"href":"https:\/\/www.nmct.ntt-east.co.jp\/en\/wp-json\/wp\/v2\/pages\/401\/revisions\/1447"}],"wp:attachment":[{"href":"https:\/\/www.nmct.ntt-east.co.jp\/en\/wp-json\/wp\/v2\/media?parent=401"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}