Panchakarma Reservation - Oneworld Ayurveda

THE PANCHAKARMA OF YOUR CHOICE

I want to book a Panchakarma for *N.B. Menstrual cycle. Please note that your first four days can interfere with your treatments (for 7-10 night stays).

Numbernight

Arrival date *

Departure date *

Arrival flight

Arrival time

Departure flight

Departure time

I am already in Bali. Please pick me up at

Hotel name

Hotel address

Room type *

Only available if you already have a roommate. We do not offer sharing rooms with strangers.

Please note: Each participant must fill out a form

YOUR PERSONAL INFORMATION

FIRST GUEST - PERSONAL INFORMATION

Title *

First name *

Family name *

Date of birth *

Home address

City *

Country *

Nationality *

Home phone number

Mobile phone number *

Email address *

Name of contact person in case of emergency

Contact person phone number

Contact person email address

ADDITIONAL INFORMATION

Have you done a Panchakarma before? *NoYes

If yes, where? *

Have you attended one of Oneworld's Retreats before? *NoYes

Do you have any serious health issues that we should be aware of before your arrival?

Food allergies / diet restrictionsPlease note that we serve food based on Ayurvedic principles. Your allergies and diet restrictions will be discussed in detail during your initial consultation with the physician.

Your clothes size *(You will receive a tunika and pants set to wear)

Your shoe size *

(You will receive a pair of flip-flops to wear)

EUUSUK/AUS

Special requestsSpecial requests Please explain if you have any physical disorders that we should be aware of. Our resort is located on a hillside and has many steps. It is not accessible for wheelchairs.

SECOND GUEST - PERSONAL INFORMATION

Title