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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 CounselingFamily TherapyPsychological 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:

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.
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
RequiredPlease click the reCAPTCHA button:

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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