Appointment

Name（required）

Visit
NewRepeater

Membership Number

Cell phone Number
Example: 080-xxxx-3645

Email（required）
Example:sample@XXXX.ne.jp

Treatment parts（required）
Hand nailToe nail

Choice of exchange nails（required）
Remove your hand nailsNo need to remove your hand nailsRemove your toe nailsNo need to remove your toe nails

Choose for hand nail staff
DACCIIEAKIRALEINAFREE

Choose for toe nail staff
DACCIIEAKIRALEINAFREE

Please fill in the menu of your choice（required）
(Please confirm about details from menu pages and confirm about campaigns from the news list)

Preferred date and time (Starting time)（required）：First choice
Month--JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctorberNovemberDecember Day--01020304050607080910111213141516171819202122232425262728293031 Time--:--11:0011:3012:0012:3013:0013:3014:0014:3015:0015:3016:0016:3017:0017:3018:0018:3019:0019:3020:0020:30

Preferred date and time (Starting time)（required）：Second choice
Month--JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctorberNovemberDecember Day--01020304050607080910111213141516171819202122232425262728293031 Time--:--11:0011:3012:0012:3013:0013:3014:0014:3015:0015:3016:0016:3017:0017:3018:0018:3019:0019:3020:0020:30

Preferred date and time (Starting time)（required）：Third choice
Month--JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctorberNovemberDecember Day--01020304050607080910111213141516171819202122232425262728293031 Time--:--11:0011:3012:0012:3013:0013:3014:0014:3015:0015:3016:0016:3017:0017:3018:0018:3019:0019:3020:0020:30

Notes