We developed these bilingual questionnaires for the purpose of assisting those who have difficulties filling out Japanese questionnaires. We made our best effort to translate Japanese questionnaires as accurately as possible but may contain mistakes. We state that we are exempt from all loss and/or damages resulting from the usage of these questionnaires.
この対訳予診票は、日本語の予診票の記入が困難な方のために作成したものです。日本語の翻訳は出来る限り正確に行うように努めましたが、誤りがある可能性があります。また、この予診票を使用したことにより生じたいかなる損害についても、私たちは免責されるものとします。 Last update July 20, 2021
| Questionnaire (PDF) | Additional Info (PDF) | Questionnaire (HTML) | Additional Info (HTML) |
|---|---|---|---|
| BCG | BCG | BCG | BCG |
| Chicken pox | Chicken pox | ||
| DPT-IPV | DPT-IPV | ||
| DT | DT | DT | DT |
| Hepa | Hepa | ||
| HIB | HIB | ||
| HPV(Cervarix) | HPV | HPV(Cervarix) | HPV |
| HPV(Gardsil) | HPV(Gardsil) | ||
| Inact Polio | Inact Polio | ||
| J-encephlitis U 3 | J-encephlitis U 3 | J-encephlitis U 3 | |
| J-encephlitis 9-13 | J-encephlitis 9-13 | ||
| J-encephlitis Over 3 | J-encephlitis Over 3 | ||
| Measles | Measles | ||
| Pneumococcal | Pneumococcal | ||
| ROTARIX | ROTARIX | ||
| ROTARIX | ROTATEQ | ||
We translated all the questionnaires and some overview documents available from Chiba city.
| Questionnaire (PDF) | Additional Info (PDF) | Questionnaire (HTML) | Additional Info (HTML) |
|---|---|---|---|
| BCG | BCG | BCG | BCG |
| Chicken pox | Chicken pox | ||
| DPT-IPV | DPT-IPV | ||
| DT | DT | DT | DT |
| Hepa | Hepa | ||
| HIB | HIB | ||
| HPV(Cervarix) | HPV | HPV(Cervarix) | HPV |
| HPV(Gardsil) | HPV(Gardsil) | ||
| Inact Polio | Inact Polio | ||
| J-encephlitis U 3 | J-encephlitis U 3 | J-encephlitis U 3 | |
| J-encephlitis 9-13 | J-encephlitis 9-13 | ||
| J-encephlitis Over 3 | J-encephlitis Over 3 | ||
| Measles | Measles | ||
| Pneumococcal | Pneumococcal | ||
| ROTARIX | ROTARIX | ||
| ROTARIX | ROTATEQ | ||