Oxygen Equipment Rental

Application Form

Send us your request first. We will check which equipment is in stock and reply to you by email.

Before you apply:

No prescription, medical certificate, or doctor’s letter is needed.
Which type we can provide depends entirely on stock. When a portable concentrator is available, we recommend it first, but you can choose.
Please attach a photo of the patient’s passport. The guarantor’s passport is optional here — you can also show it when you receive the equipment.
The equipment is received at our clinic in Sapporo only.
In a life-threatening emergency, call 119.

Fields marked * are required. Please write in English.

First Name *

Last Name *

Date of Birth *

Email Address * (we will send a copy of your request here)

Home Address *

Country *

Diagnosis (your medical condition) * (e.g. COPD, interstitial lung disease)

Arrival date in Hokkaido *

Departure date from Hokkaido *

Where will you stay? * (hotel name and city — if not decided yet, write "Not decided")

Which type would you like? *Portable oxygen concentrator (recommended if in stock)Oxygen cylinders + stationary concentratorNo preference

Date you need the equipment *

Time you need the equipment * (e.g. "around 10:00", "afternoon")

The equipment is received at our clinic in Sapporo only.

Photo of the patient's passport * (photo page — JPG or PNG, max 5MB)

Photo of the guarantor's passport (optional — you can also show it when you receive the equipment. Your travel companion can be the guarantor.)

Anything else you would like to tell us