Please note: This form is for the
Fertility Detox Retreats only.
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Note: fields marked with * are mandatory |
* Name: |
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Address: |
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* Home Telephone: |
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Work Telephone: |
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Mobile Telephone: |
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* Email Address: |
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* please repeat Email Address: |
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| ** Please note that each person booking needs to submit a separate booking form and health questionnaire. |
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| Type of accommodation required: |
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Single person own room en-suite £1,425 / 1900 Euros |
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Single person, own room, shared bathroom with one other £1,225 / 1630 Euros CASA MORISCO ONLY |
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2 people sharing, en-suite bathroom £2,150 / 2860 Euros |
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Shared wooden chalet with 2 beds and 2 bathrooms en-suite - £1,150 / €1550 per person
MOINHOS VELHOS only |
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Dates required:
(please note availability information, contact us to confirm if 'limited places remaining' is indicated, thank you.) |
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Sept 6th - 13th
2008 |
Moinhos Velhos, Portugal
Retreat full |
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October 4th - 11th
2008 |
Cortijo Romero, Spain
Retreat full |
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Nov 30th - Dec 7th
2008 |
Casa El Morisco, Spain
2 places available |
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January 11th - 18th
2009 |
Casa El Morisco, Spain
places available |
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Jan 25th - Feb 1st
2009 |
Casa El Morisco, Spain
places available |
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March 28th - April 4th
2009 |
Cortijo Romero, Spain
places available |
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May 9th - 16th
2009 |
Cortijo Romero, Spain
places available |
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June 21st - 28th
2009 |
Casa El Morisco, Spain
places available |
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July 4th - 11th
2009 |
Cortijo Romero, Spain
places available |
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September 5th - 12th
2009 |
Cortijo Romero, Spain
places available |
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Nov 29th - Dec 6th
2009 |
Casa El Morisco, Spain
places available |
Please Note: In the event that your ideal dates are shown as fully booked, you can let us know if you would wish to be placed on a reserve booking list for those dates
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| Detox Programme Health Questionnaire |
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Age: |
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Weight (kg): |
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Height (m): |
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| Medical History |
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| Are you receiving treatment from a GP? |
| No |
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Yes |
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If yes, for what condition? |
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| Please provide details of medications (names & doses) and details of any abnormal test results you may have had: |
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| Please give details of any other treatments used such as homeopathic remedies, nutritional supplements etc. |
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| Health Profile |
| Please make a list of all the health problems that you would like to clear up and indicate how long you have had these problems (eg. headaches - 7 years). Please start at number 1 with the problem of the longest duration, ending with the problem that occurred most recently. |
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Click here if you would like to receive our
FREE QUARTERLY NEWSLETTER |
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| How did you hear about Detox International? |
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| Transfers to and from the airport are INCLUDED in the price. Please let us know your flight details AS SOON AS POSSIBLE so we can arrange suitable pick up times. |
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Alternatively, request a booking form by calling or emailing.
