```html Medical Tourism Service Application | Eudaimonia Consultancy LLC

Medical Tourism Service Application Form

Eudaimonia Consultancy LLC — 4-D-22, Empire Heights Business Centre, Business Bay, Dubai, UAE

1. Applicant Information

Full Name *

Date of Birth *

Nationality *

Passport Number

Email *

Phone / WhatsApp *

2. Requested Services

Please select the services you wish to apply for (check all that apply).

Introduction to Japanese stem cell clinics Medical appointment coordination and scheduling Medical interpretation services Translation of medical records and related documents Travel assistance (flight arrangements, local transportation in Japan)

3. Preferred Clinic / Treatment (optional)

Clinic Name (optional)

Type of Treatment (optional)

Notes / Questions (optional)

4. Acknowledgement and Disclaimer

By applying for the Services, the Applicant acknowledges and agrees that:

Consultant is not a medical provider and does not provide medical diagnosis, treatment, or medical advice.
All medical services are provided solely by the selected medical institution in Japan.
Consultant’s role is limited to coordination, interpretation, translation, and travel-related assistance.
Medical outcomes, treatment decisions, and clinical responsibility rest entirely with the medical institution.

5. Fees and Payment

The Applicant understands that:

Service fees for coordination, interpretation, translation, and travel assistance may apply.
Medical fees charged by the clinic are separate from Consultant’s service fees.
Any applicable fees will be explained prior to confirmation of services.

6. Confidentiality and Data Use

The Applicant consents to Consultant collecting, using, and sharing personal and medical information solely for the purpose of providing the requested services, in compliance with applicable data protection and privacy laws.

7. Limitation of Liability

The Applicant agrees that Consultant shall not be liable for:

Medical outcomes, complications, or malpractice
Decisions made by medical professionals or clinics
Delays or changes caused by medical institutions, airlines, or third-party service providers

8. Governing Law

This Form and related services shall be governed by the laws of Japan, unless otherwise required by applicable regulations.

9. Confirmation and Consent

Please read carefully. You must agree before submitting.

Fields marked with * are required.

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