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Contact Form

If you would like to make an appointment or ask us questions, please use the form below or the following email address : [email protected].

If you have not heard back from us within 48 hours, please check your email spam folder. If you still don’t seem to have received an email response from us, please contact us at [email protected].

Currently, due to the high volume of enquiries, we may need to add you on our waiting list.
In addition, we are currently not accepting any enquiries for clients under the age of 8. Thank you for your understanding.

We are currently not offering counseling and psychotherapy services in Chinese. 

Please fill out the form in English.

    RequiredName
    RequiredEmail Address* If your email address ends with .mil, .msn, or .hotmail, then please be sure to add a backup email address below.
    OptionalBackup Email* In case your primary email filters block our email reply to your enquiry.
    OptionalTelephone
    RequiredI would like to see a provider at:

    * For Counseling: Currently due to the high volume of enquiries, we are expecting a longer waiting time for people who are available only for in-person sessions.
    * For Testing: Please note that we can offer intake consultation online but if you are looking for a full evaluation, it would require you to be in-person in our Shintomi office.

    RequiredWhat time of day/days might work for you for your appointment?
    * Multiple selections allowed    		 Before 4pm on weekdaysAfter 4pm weekdaysWeekend

    * For Counseling: Currently due to the high volume of enquiries for weekends/after 4pm on weekdays, we are expecting a longer waiting time for people who are available only those days/times.

    RequiredI am seeking: Individual CounselingPsychological Testing

    Learn more

    RequiredI am looking for services for:

    MyselfAnother adultA minor and I have parental authority (e.g., my child)

    RequiredI am:

    18 years old or olderLess than 18 years old

    RequiredTheir email:

    RequiredTheir name:

    RequiredTheir age:

    OptionalTheir email:

    * For older minors (16 and 17 year olds) please let us know their email address if you would like us to CC them into our email reply.

    RequiredPartner's name:

    RequiredPartner's email address:

    RequiredPlease provide the names, ages and relationships of those seeking to attend the session.

    RequiredType of Service:

    Mental health assessmentADHD assessmentPersonality assessmentASD assessment (*Currently we are NOT providing ASD assessment)Learning Disorder assessment (*Currently we are NOT providing LD assessment)Cognitive Impairment & Memory Loss assessmentOthersNot sure yet

    RequiredI am looking for services for:

    MyselfAnother adultA minor and I have parental authority (e.g., my child)

    RequiredI am:

    18 years old or olderLess than 18 years old

    RequiredTheir email:

    OptionalTheir email:

    * For older minors (16 and 17 year olds) please let us know their email address if you would like us to CC them into our email reply.
    RequiredHave you/the person had an appointment with us before? NoYes

    OptionalPlease provide further information:

    RequiredDo you already have an existing Psynary account? NoYes
    Optional[For counseling clients only] Please list suitable language(s) if you are seeking a therapist who speaks a language other than English. * We are currently NOT offering Mandarin-only sessions. Please also note that services in languages other than English are limited and may involve a longer wait on our waiting list for services.
    RequiredAre you (the client) currently outside of Japan? NoYes
    RequiredDo you (the client) have SOFA in Japan?
    * SOFA: Status of Forces Agreement    		 NoYes
    RequiredHealth insurance information
    No insuranceJapanese National Health InsurancePrivate health insurerTRICARE PrimeTRICARE other

    What is TRICARE?

    RequiredPlease read and check the box below:

    I will be paying for services myself.

    RequiredPlease read and check the box below:

    I understand Tokyo Mental Health cannot accept Japanese national health insurance (NHI) including residence-based national health insurance (NHI) and employer-based national health insurance. I will be paying for services myself.

    RequiredPlease read and check the box below:

    I have a private health insurance plan so I will pay by myself and claim retrospectively.

    RequiredPlease read and check the box below:

    I have TRICARE Prime and an authorization form or it is pending.

    OptionalPlease enter your Sponsor SSN or your DBN:
    * We need this information to confirm your TRICARE eligibility before we can proceed.

    Sponsor SSNDBN

    RequiredPlease read and check the box below:

    I have another TRICARE plan (e.g. Select, Plus) and will claim retrospectively.

    OptionalPlease enter your Sponsor SSN or your DBN:
    * We need this information to confirm your TRICARE eligibility before we can proceed.

    Sponsor SSNDBN
    RequiredAdditional information

    Maps and Access Info

    Please click the buttons below to see the maps, access info, and other location-specific information about our offices.

    Tokyo Mental Health
    Shintomi Therapy Office

    6F Urbane Mitsui Building, Shintomi 2-4-6, Chuo-ku, Tokyo [Map ]
    Location Details

    Psychiatry Clinic
    at American Clinic Tokyo

    No.1 Niikura Building 3F, 1-7-4 Akasaka, Minato-ku, Tokyo [Map ]
    Location Details

    TMH Okinawa
    Mihama Therapy Office

    301 Hawk Town II, 2-5-23 Mihama, Chatan, Nakagami-gun, Okinawa [Map ]
    Location Details
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