Home · 指さし問診カード

Clinic Card Maker — Say It in Japanese Without Speaking

By Dr. Masa · physician licensed in Japan

Tick your symptoms, temperature, allergies, medications and insurance in English; get a clean bilingual card to show at the reception desk — every Japanese line is checked and approved by a physician licensed in Japan, not produced by a translation app. Print it, save it as a PDF, or just hold up your phone. Everything stays in your browser; nothing you type into the card is sent anywhere.

1Who is the patient?

Weight and height (optional)

For children, doctors usually base medicine doses on body weight.

2Symptoms

Tick everything that applies.

Temperature (if you measured it)
Since when?
Getting better or worse?

3Allergies & past side effects

Bad reactions to a medicine (not allergies)

A side effect you have had before — for example, a medicine that made you very drowsy or sick.

4Current medications & conditions

Current medications — OTC medicines and supplements too

Include over-the-counter medicines and supplements. Medication names stay in English — generic names are understood internationally.

Existing conditions
If applicable — could the patient be pregnant?
Past surgery or hospital stays

5Insurance, contact and documents

Phone number (optional)
Documents you need

This card replaces the language barrier, not the intake questionnaire — staff may still hand you a 問診票 and will help you through it. Japanese translations are fixed pairs approved by a physician; your free-text entries appear in English with a note asking staff to read them. Temperature, weight and height appear on the card in °C, kg and cm. See also: what happens at a first visit · which clinic type you need.