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Booking a treatment

Last name*:

First name*:

Street*:

Postcode / Town*:

E-Mail*:

Sponsor*:

If sponsor is "statutory health insurance":

Day of arrival*:

Day of departure*:

Date you plan to collect your schedule*:

Time of collection (approx.)*:

The remaining schedule will be cancelled if this is not collected.

Exact number and type of treatment
(We are unable to process this order without this information!!)

1. Treatment:

Quantity*:

Exact name of the treatment*:

2. Treatment:

Quantity:

Exact name of the treatment:

3. Treatment:

Quantity:

Exact name of the treatment:

4. Treatment:

Quantity:

Exact name of the treatment:

5. Treatment:

Quantity:

Exact name of the treatment:

Additional wishes:

I would like to have the treatments in this time period if possible:

Notes:

We will attempt to fulfill your wishes wherever possible. Please note that planned dates are subject to possible changes at short notice (due to holiday, illness).

* Required field

Booking a treatment

Download our booking form as a PDF or Word document.

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Download as Word

To view the PDF you require Adobe Reader, which can be downloaded hier free-of-charge.

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