Our Request

Tempura Hiraishi is committed to serving only the freshest and finest seasonal ingredients available providing service of the highest quality.

Please make your request for a reservation from the form below and then secure your reservation by completing payment for your courses.

We look forward to your visit at Tempura Hiraishi.

Date of Reservation*

Time of Reservation*

Menu

Number of People*
  • Adult

※We are sorry but children under 12 years of age are not allowed.

 

Dinner Course

￥15,000 (￥16,500)￥20,000 (￥22,000)
※Price in ( ) includes the 10% Tax. An additional 10% service charge is required.

Name*
  • First Name
  • Last Name
Gender
Country*
Hotel Name / Place of Stay*
Emergency Contact Phone No.*
E-mail*
E-mail (Confirmation)*
Please check any that apply:*
【1】Someone has a food allergy in the reservation .【2】Someone in the reservation has a food that they dislike.【3】Someone in the reservation has a food that they cannot eat due to religious belief.【4】Everyone in the reservation can eat anything.【5】Due to an allergy, the restaurant cannot use the same oil that has been used to cook shrimp, crab or shellfish.
Any food allergies or food that you cannot eat:


※If anyone in your group has any allergies or special dietary requests, please list in as much detail what foods cannot be eaten and also the number of people that it applies to (if it is not listed then the dietary request will be applied to every member of the group).
※Please note that the restaurant will be unable to accommodate any sudden dietary requests made at the restaurant on the day of your reservation, therefore please make sure to list it here.

※ Please note that the food you cannot eat may be used to cook other customers' meals at the restaurant. Please let us know if the allergy is a serious or sensitive one (Is it okay if the restaurant uses the same oil to cook your food when cooking other customers food?)
Comments or Requests
How did you hear about us?

How to make a reservation

  • 1. An automated confirmation email will be sent to you once the request is submitted.
  • 2. My Concierge Japan will check to see if a reservation can be made on the date/time you requested.
  • 3. If seating is available, an email and URL link will be sent to you from where you can complete payment for your reservation with a credit card or PayPal. Please complete payment within 48 hours. Once payment is confirmed, an email will be sent to you to let you know that your reservation has been finalized.

  • CANCELLATION POLICY:
    ※ All cancellations made at least 3 days before their reservation date is eligible for a full refund.

    ※Any cancellation made within 2 days of the reservation date (2 days before, a day before and on the date of the reservation) will not be eligible for any refund.

    ※Any changes to the reservation are required to be made at least 3 days before the reservation.

Checklist of 5 questions to keep you safe from COVID-19.*

This is a checklist created in order to keep you and other dining guests, as well as the restaurant staff, safe from the spread of COVID-19. All measures below are strictly required to be kept by all guests and restaurant staff alike. Thank you for your understanding and cooperation.
Please check either of the ☑ below, select the current date and enter your full name.

A. Prior to the reservation date.

  1. I currently have a body temperature of 37.5°or higher.
  2. I have experienced one of the following symptoms in the last 14 days: fever / coughing / breathlessness / fatigue / impaired sense of taste.
  3. I have come in contact with a person who has experienced the above symptoms in the last 14 days.
  4. I have been to a country or area considered a Travel Warning Level 3 by the Ministry of Foreign Affairs of Japan in the last 14 days.
  5. I have been to or attended a facility, event or meeting (excluding public transportation) considered a cluster infection risk in the last 14 days.

I apply to none of the aboveI apply to one or more of the above

B. On the reservation date.

  1. I will wear a mask to the restaurant and will only remove it once I am seated
    YesNo
  2. I will disinfect my hands with the alcohol disinfectant placed at the entrance of the restaurant
    YesNo
  3. I understand social-distancing and the need for sufficient space between seats, and will refrain from actions such as talking too loud or too close to the others
    YesNo
  4. I agree to being refused entry to the restaurant if my body temperature exceeds 37.5°when it is measured by the restaurant staff at the restaurant.
    YesNo

I hereby certify that the above information is true and correct. I agree to cancel my reservation (or be refused entry) if there is any discrepancy regarding the above with any member of my party on the day of the reservation. I fully understand that it is my responsibility to inform all other members of my party of the above and to contact My Concierge Japan in order to facilitate a cancellation or alteration to the reservation if there is any member that applies to one of the points above.
I agree to the Cancellation Policy in regards to refunds due to any cancellation or refusal of entry.

Please check your email spam/junk folder. Please also confirm that your email address is correct. You will receive an confirmation email immediately after pressing SEND.

I agree to the privacy policy and all of the terms above.