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 (medication prepared)
Order in advance to reserve stock, then collect after your consultation when you visit. [Repeat visit] Visit clinic (medication prepared)
No advance payment needed. Reserve your medication and a visit time below; collect after your consultation when you visit. ※ Available to patients with a confirmed history of pickup/purchase at our clinic. If you are already our patient, please let us know on WhatsApp (+81-80-7798-2117) after registering. 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. If you want to be sure to receive it, choose "Visit clinic — pay in advance." 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

Shipping address

Postal code*

Address*

⚠ 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.

About you

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

Email address*

Full name*

Phone number*

Date of birth*

Gender*

Name of the person who referred you (optional) If a patient of our clinic referred you, please enter their name.

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

Self-injection experience*

Yes No

💳 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.

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.

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.

🎁 Registered members receive a ¥1,000 coupon each time they refer someone (only if the person you referred enters your name in the “Referrer’s name” field on their first application).