The Kanagawa International Foundation has prepared a Medical Questionnaire in various languages（a questionnaire that will inform a doctor of your condition, such as where you are experiencing pain, etc.）for use by citizens of foreign countries that is helpful when visiting a physician.
People in Itoigawa can also make use of this information, so please feel free to use it.
Here is the homepage for the Kanagawa International Foundation.
On this page is a Medical Questionnaire that is available in 15 different languages.
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The Multi-Lingual Medical Questionnaire contains a diagnosis section for each specialization of medicine (Ophthalmology, Surgery, Obstetrics and Gynecology, Dentistry, Otolaryngology (ear, nose and throat), Pediatrics, Orthopedic Surgery, Internal Medicine, Neurosurgery, Dermatology).