Day-Long Session First Name * Last Name * Prefix * Mr.Mrs.Ms. Date of Birth * Marital status * SingleMarriedSeparatedDivorcedWidowed Address Address * City * State * Zip/Postal * Country * Email * Phone * Weight * Height * Current health issues * If diabetic, last fasting blood glucose reading If hypertensive, last blood pressure reading Preferred package * Restore Wellness ($250) Relax and Learn ($150) Preferred hydrotherapy treatment – pick one * Sauna Infrared Sauna Allergy Spray Full Body Whirlpool Preferred date * November 19, 2023November 20, 2023November 21, 2023 How did you hear about us? * Facebook, Instagram, Whatsapp Flyer Mail in Flyer Poster Email OtherOther Are you coming with a friend? * Yes No Friend's name * If you are human, leave this field blank. Submit
