Medical Diet — My Page | Yuushin Medical Clinic

① Treatment & meds ─ ② Health & payment ─ ③ Booking

Choose your visit type and medication

Online consultation
After an online review by the doctor, we ship your medication to your home. No clinic visit required. Visit clinic
Book a visit below. Also choose this if it is your repeat visit and your medication is not yet decided.

Same-day payment (collect at clinic) does not reserve stock, so medication may be out of stock when you visit. This page only books your visit date and time (medication selection and payment are handled at the clinic).

Select medication

Shipping: free for orders of ¥35,000 or more / ¥1,500 under ¥35,000

⚠ No-Return / No-Refund Policy

Due to the nature of pharmaceutical products, we cannot accept cancellations, returns, exchanges, or refunds once payment has been completed.

For quality and safety reasons, dispensed prescription medication cannot be reused or resold after it leaves our clinic.
Your medication is shipped under refrigerated (cold-chain) conditions to preserve its quality.

I have read and agree to the no-return / no-refund policy above.

About you

These details are required for your application. Your information is used only for your medical care.

Email address*

Full name* Enter your name exactly as it appears in your passport (Latin letters A-Z only).

Phone number*

Date of birth*

Gender*

Your Home Address

Please enter your current residential address.

Postal code*

Address*

Apartment/Building name & room number (optional)

Country*

Shipping address

Ship to my home address above

Postal code*

Address*

Hotel / apartment name & room number (optional)

⚠ Shipping Address Policy

Please verify your shipping address carefully before submitting. If your parcel is returned due to an incorrect or undeliverable address:

A redelivery fee of ¥5,500 will be charged.
If you decline redelivery, the medication will be disposed of with no refund — including the medication cost.

I have read and agree to the shipping address policy above.

Medical Information(enter "none" if not applicable)

Current medications*

Current medical conditions*

Past medical conditions* Patients with a history of pancreatitis or bowel obstruction may not be eligible

Drug / food allergies*

BMI confirmation*

Height (cm)

Weight (kg)

Eligibility Confirmation*

Do any of the following apply to you?

Family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 (MEN2)
Currently pregnant, breastfeeding, planning pregnancy within 3 months, or within 3 months postpartum
17 years old or younger
Currently being treated for diabetes

None of the above apply One or more of the above apply

💳 Credit card

🔒 Your card is securely registered through Stripe, a payment platform trusted by businesses and clinics worldwide. All card details are handled by Stripe — our clinic never stores or sees your card number.
About Stripe →

Your card will be charged after the consultation. No payment is taken now.

Name on card* Enter the name exactly as printed on your card, using Latin letters. Only cards in your own name can be used — cards belonging to family members or anyone else cannot be registered.

I confirm that the card I am registering is in my own name and will be used by me.

By providing your card information, you authorize Yuushin Medical Clinic to charge your card for payments in accordance with their terms.

Please select one of the following

Google Meet (video call)
Select a date and time from the calendar Upload ID document
⚠ Please upload a photo ID.
Name and date of birth must be clearly visible (residence card, passport, driver’s licence, student ID, etc.)

Online consultation booking

After an online review by the doctor, we ship your medication. No clinic visit required.
Select a date, then choose your preferred time.

Do you need customs documentation? (FREE)

Passport Number*

Passport photo*

Upload a photo of the page showing your photo, name and passport number. JPEG/PNG/PDF, up to 10 MB.

Confirmations

I have confirmed the consultation fee policy
(The consultation covers identity verification and medication review (per Ministry of Health guidelines).
Consultation fee:
　¥0　Medication and dosage already decided
　¥3,300　Consultation in Japanese
　¥5,500　Consultation in English)

Create an account with the information entered (optional)
If checked, we will email you a link to set a password. Next time, you can simply log in to order and view your history.