Online Reservation Form

Last Name:
First Name:
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FOR FOREIGN NATIONALS / NON RESIDENT INDIANS

Passport No:
Date of Issue
Place of Issue:
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Accommodation Requirments

Accommodation Required:

No. of People:
Date of Arrival
Date of Departure

Have you been to Ayurveda Sanctuary before


PURPOSE OF STAY


Ayurveda Sanctuary Programmes	Weight Loss Arthritis
	Age Reversal Heart Disease Reversal
	Skin Diseases Stress Management
	Asthma Diabetes

Treatments	Panchakarma Abhyangam
	Pizhichil Udvarthanam
	Chavittiuzhichil Dhara
	Dhanyamla Dhara Kizhi
	Njavarakizhi Marma Therapy


Please indicate mode of payment:	Cash Bank Draft Credit Card

Other specifications

	Terms & Conditions: 1. The Management reserves the right of admission or discharge of any patient without assigning any reason whatsoever. 2. No patient is allowed to go out during his/her stay, without permission. 3. Smoking, taking tea, coffee, alcohol and outside food are strictly prohibited. 4. The extension of stay can be considered only on the advice of our doctors and subject to availability of accommodation. 5. Medicines of any sort if considered essential, our doctors shall advise. 6. Incase of postponement/ cancellation, 3 clear days notice is to be given. I have read the terms & conditions and agree to abide by them.



	Please fill in ALL columns and mail us, this will help us to advice you correctly on the therapy and indicate costs through our special offer.

� 2007, by the Ayurveda Sanctuary