For inoculations, please use the pre-examination slip sent by the city.
If you have lost or damaged the pre-examination slip that was sent to you, please use the download version below.

(Explanatory notes) Please note that there are two types of pre-examination questionnaires: one for 6 months to 4 years old, 5 years old to 11 years old (3rd time), 12 years old and over, and 5 years old to 11 years old (1st and 2nd times). Please give me.

(Note) Points to note when downloading

• Standard: A4 size, one color on one side
• Printing method: Please print at the actual size without reducing or enlarging.

[For 6 months to 4 years old, 5 years old to 11 years old (3rd time), 12 years old and older] Pre-examination form download version (PDF: 278KB)

[for 5 years old to 11 years old (1st and 2nd time)] Pre-examination vote download version (PDF: 278KB)