Please feel free to use “Multilingual Medical Questionnaire Sheet”

At Illness/Injury page in MIA website,you can download “Multilingual Medical Questionnaire Sheet” that is helpful in communication with hospital staff to describe your health conditions. Please feel free to download and use it. (The sheet was completed by MIA Multilanguage and Multicultural Community Healthcare Support Promotion Group.)

Musashino International Association (MIA)
SWING 9F, Sakai 2-14-1,Musashino-shi , Tokyo 180-0022
TEL 0422-36-4511 FAX 0422-36-4513
Open: TUE - SAT 9:00-17:00(Closed on SUN,MON and Public Holidays)