Detox and Wellness Reservation Form

1. Personal Information:
  First Name
  Last Name
  Email address
  Country of Residence
  Gender Male
Female
2. Select the dates you would like to come for:
  Arrival Date
  Departure Date
3. Select your choice of accommodation:
  Single
Shared
Non-residential (if you do not need accommodations)
4. Detox Program - indicate your desired length of time:
  Personalized Detox Program
3 days
5 days
7 days
10 days
  Add on any extra nights:

on Detox Program (€ 98 share/ € 128 single)
or on Yoga Residential stay (€ 80 share/ € 108 single)		  

# nights
# nights
5. Wellness Program - indicate your desired program and length of time:
 
  Add on any extra nights:

on Wellness Program (€ 80 share/ € 108 single, only includes accommodation and meals, any extra treatments special discount at 30%)
or on Yoga Residential stay (€ 80 share/ € 108 single)		  

# nights
# nights
6. One-to-One 7 Day Personal Retreat (Rates: € 1,890 single/ € 1,690 share)
Select this program
  Add on any extra nights:

on Wellness Program (€ 80 share/ € 108 single, only includes accommodation and meals, any extra treatments special discount at 30%)
or on Yoga Residential stay (€ 80 share/ € 108 single)		  

# nights
# nights
7. If there is a need please add any additional information here:
Samahita Wellness does not claim to be a medical faculty and advises that the health of the individual is their own responsibility. It is important to seek medical advice regarding any health concerns before participating in a detox program. We are not in the position to treat people with serious mental or emotional illnesses who are on prescribed psychiatric medication. If you are currently taking any serious medication for health issues please provide us with a note from your doctor regarding the condition and his/her's approval for you to partake in such a program. Thank you.
 

“Things that are truly of merit require time and patience in order to be fulfilled”
∼ Swami Kripalu

 

 
 
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