
To take a yellow fever vaccination and an international certificate of
vaccination or prophylaxis (yellow card), you need to make a reservation.

To make a reservation, call numbers in the following table.
Yellow Fever Vaccination Centers near Tokyo
For more information, http://www.forth.go.jp/useful/yellowfever.html (Japanese only)
Names of centers
Reservation
numbers & hours
Vaccination dates & hours
Travel Clinic in National Center
03-3202-1012
for Global Health and Medicine
15:00~17:00
(in Shinjuku area)
every Tuesday and Thursday
Travel Clinic in Tokyo Medical
University Hospital
(in Shinjuku area)
03-5339-3137
16:00~17:00
every Friday afternoon
Tokyo Clinic, Japanese
Quarantine Association
(near JR Tokyo Station)
03-3527-9135
Monday to Friday 10:00~10:30
Saturday
9:30~
Nippon Medical School Clinic
(in Narita Airport)
0476-34-2310
9:00~16:00
every Tuesday afternoon
(except 3rd Tuesday)
Tokyo Quarantine Station
(in Odaiba area)
03-3599-1515
9:00~17:00
every Tuesday afternoon
Yokohama Quarantine Station
045-201-4456
9:00~17:00
every Wednesday afternoon

As yellow fever vaccine is limited, it might be difficult to book during
high travel season (July to September and January to March).

It would be better to call 1 month before your departure at latest.
How to book the yellow fever vaccination at Tokyo Quarantine Station?
How to book
1. Call 03-3599-1515 attended by Japanese-speaking persons (Monday to
Friday 9:00~12:00,13:00~17:00)
2. Get your reservation number
3. Fax 03-5530-2152 a photocopy of your passport with your reservation
number
Having your information correctly, please call us assisted by Japanese-speaking persons.
You will be asked;
-
Details of your trip (e.g. departure date, destinations, style of trip)
Personal information (e.g.name spelling, date of birth, nationality)
Past and present medical history
Schedules of other vaccinations
etc.
 To complete your reservation, you need to fax a photocopy of your passport with your
reservation number.
 For canceling, please call us by the day before at latest.
Appointment time
1:30p.m
 Be punctual and do not be late for your appointment.
 This appointment time is subject to change in accordance with the number of
applicants. For particulars, apply to us.
What you need on the day of vaccination
Documents: “Application for vaccination” and “Vaccination inquiry”
Cost:
¥ 11,180 (including issuing a certificate)
The fee should be paid by revenue stamps, called Syunyuinshi, which can be bought at
the shop on the 1st floor of the building (cash only).
ID-card：
You need to show your ID-card at the entrance of our building. (e.g. Residence Card)
 You don’t need to bring your passport with you; however, the signature on the
certificate should be the same as your passport.
 As your certificate will be issued after 30 min. observation, do not go back home soon
after vaccination.
Access
See the map: http://goo.gl/maps/4GPho
Take Yurikamome Line and get off at Telecom Center Station.
Tokyo Harbor Government Building is 10 minutes’ walk of the station.
Tokyo Quarantine Station
8F of Tokyo Harbor Government Building
2-7-11 Aomi, Koto-ku, Tokyo 135-0064 Japan
Tel +81-3-3599-1515
Fax +81-3-5530-2152
Sample of application form
（表）
様式第八の二
Please bring revenue stamps without sticking on this form
予防接種に関する申請書
APPLICATION FOR VACCINATION
申　請　者　住　所
Address of applicant
申　請　者　氏　名
Name of applicant
※Date of vaccination
20 １5．３．１
申　請　年　月　日
Date of application (y．m．d)
東 京 検 疫 所 長
殿
※ If you apply for other members of your
family with you, fill in the total amount of
money.
1 person ・・・11,180円,
2 persons・・・22,360円
3 persons・・・33,540円
性別
Sex
Ichiro J,Keneki
手　数　料　金
Amount of fee
０３０１ TK ０１
If you have 2 passports, please fill
in the nationality of your passport
which you take along
被　接　種　者
Persons to be vaccinated
西暦生年月日
予防接種の種類
行先地
Date of birth Kind of vaccination Destination
ICHIRO JOHN KENEKI
M
1977.1.1
Yellow Fever
Ghana
（ふりがな）
（ふりがな）
（ふりがな）
（ふりがな）
記載上の注意
Notes：
備考
Remarks
(国籍　Natinonality)
(y．m．d)
（ふりがな）
11,180
円
予約整理番号（予約の時にお知らせした番号です）
Reservation number
予防接種の施行を下記の通り申請します。
予防接種の施行に関する証明書の交付を申請します。
I apply for the execution of vaccination as specifield below.
I apply for the issuance of the certificate with regard to vaccination.
氏名
Name
ICHIRO JOHN KENEKI
署　名
Signature
To the chief of Tokyo Quarantine Station
your passport name
東京都○○区△△2-7-1
１．楷書で記入すること。
２．不要の文字は抹消すること。
１．Fill in block letters.
２．Strike out the unnecessary indications.
※ いただきました個人情報は､当検疫所にて厳重に管理し､予防接種事業以外の目的では使用いたしません
※　Your contact information will be held in the strictest confidence as per our privacy policy.
Ghana
（表）
収入印紙貼り付け位置 (STAMPS HERE)
様式第八の二
予防接種に関する申請書
APPLICATION FOR VACCINATION
申　請　者　住　所
Address of applicant
申　請　者　氏　名
Name of applicant
20　．　．
申　請　年　月　日
Date of application (y．m．d)
東 京 検 疫 所 長
殿
署　名
Signature
To the chief of Tokyo Quarantine Station
手　数　料　金
Amount of fee
円
予約整理番号（予約の時にお知らせした番号です）
Reservation number
TK
予防接種の施行を下記の通り申請します。
予防接種の施行に関する証明書の交付を申請します。
I apply for the execution of vaccination as specifield below.
I apply for the issuance of the certificate with regard to vaccination.
氏名
Name
性別
Sex
被　接　種　者
Persons to be vaccinated
西暦生年月日
予防接種の種類
行先地
Date of birth Kind of vaccination Destination
(y．m．d)
（ふりがな）
（ふりがな）
（ふりがな）
（ふりがな）
（ふりがな）
記載上の注意
Notes：
１．楷書で記入すること。
２．不要の文字は抹消すること。
１．Fill in block letters.
２．Strike out the unnecessary indications.
※ いただきました個人情報は､当検疫所にて厳重に管理し､予防接種事業以外の目的では使用いたしません
※　Your contact information will be held in the strictest confidence as per our privacy policy.
備考
Remarks
(国籍　Natinonality)
ＶＡＣＣＩＮＡＴＩＯＮ ＩＮＱＵＩＲＹ
ＴＯＫＹＯ ＱＵＡＲＡＮＴＩＮＥ STATION
Name
□Male
Date of today：
(Print)
□Femalｅ
Date of birth：
Name of parent or guardian
/
/
Nationality:
Telephone number:
Please fill out this form correctly. The parent or guardian should fill out this form for children.Check the following.
How is your condition today?　□　good
□　bad
Body temperature：
How many times have you ever taken yellow fever vaccinations?
Last time: （　）yrs ago
Adverse effect ( □　No
□　First time　□　（　Date of departure：　）time
□　Yes Symptom:
Purpose of visit：　□business
Destination：
℃
□sightseeing
)
□other（　）
The length of your visit：
Are you suffering from any of following diseases or having any of following treatments?
□　Yes
□　No
□　Fever
□　Renal disease
□　Diabetes
□　Heart disease
□　Liver disease
□　Asthma
□　Skin disease
□　Nervois system disorder
□　Blood disease
□　Immune deficiency symdrome
□　Radiotherapy
□　Chemotherapy
□　Common cold
□　Dental disease
□　Epilepsy
□　Other （　）
Are you taking any medicine for example,cortisone,anticanser drugs,etc ?
□　Yes
□　No
Have you been hospitalized for any medical treatment ?
□　Yes
□　No
Did you have any illness especially Measles,Rubella,Chickenpox or Mumps in the past 4weeks ?
□　Yes
□　No
Have you received a blood transfusion,plasma or γ-globulin in the past 3months ?
□　Yes
□　No
Is there anyone who has suffered from Measles,Rubella,Chickenpox,Mumps or other infectious
disease in your family,colleagues or,if an infant,playmates in the past 1month ?
□　Yes
□　No
Did you have any vaccination in the past 4weeks ?
□　Yes
□　No
□　Polio
□　Measles
□　Rubella
□　Chickenpox
□　Mumps
□　Hepatitis A
□　Hepatitis B
□　Rabies
□　Tetanus
□　Typhoid
□　Influenza
□　BCG
□　Japanese encephalitis
□　Other （　）
Are you allergic to egg or chicken,gelatin product or any foods ?
□　Yes
□　No
Are you allergic to any drugs or vaccinations ?
□　Yes
□　No
Is there anyone who has allergic reactions to any drug or vaccination in your family ?
□　Yes
□　No
Are you (possibly) pregnant now ? Do you think you may be pregnant ?
□　Yes
□　No
Are you breast feeding now?
□　Yes
□　No
□　Yes
□　No
Did your child have any abnoemality such as delay of development,pointed out during medical
examination ?
□　Yes
□　No
Did your child who have any convulsions in the past one year ?
□　Yes
□　No
Do you have a child who has been diagnosed with congenital immune deficiency ?
□　Yes
□　No
If aninfant,the parents or guardians have to answer the following questions ?
Did your child have any abnoemality during delivery ? Birth weight (　)g
I understood the information given to me about immunization,results of medical examination and cautions for after
vaccination. I request that myself,or the above named child,be immunized with the vaccine.
Signature(if an infact,signature of the parent or guardian)
※　Your personal information will be held in the strictest confidence as per our privacy policy.