New Health and Fitness form

  • Personal Details

  • Emergency Contact

    We strongly recommend you take out private travel insurance to cover any eventuality. Please bring your policy details with you on the holiday
  • Outbound Flight Details

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    24 hour clock please
  • Return Flight Details

  • :
  • Medical details and physical activities readiness

  • Has your doctor ever said you have heart trouble? If so, please specify
  • Do you ever feel faint or have spells of dizziness?
  • Has your doctor ever told you that you have back problems? If so, please specify
  • Are you currently taking any form of medication? If so please specify
  • Do you currently have a disability or a communicable disease? If so please specify
  • Do you have any other medical issues, (non-diet related) allergies or injuries that you should inform us about? If so, please specify
  • Diet

  • Do you have any allergies? If yes, please specify
  • Do you have any other special dietary requirements? If yes, please specify
  • How many coffees/teas do you drink per day?
  • How many units of alcohol do you consume per week?
  • Do you smoke?
  • Current Activity Programme

  • Describe your fitness level and any current forms of exercise
  • Aims and expectations

  • What are you hoping to achieve on your in:spa retreat with us?
  • Confirmations

    We are really careful with your data. We ask for the information in this form so that we can communicate your needs and requirements to our team of professionals who will ensure you get the very best from your retreat. We will retain your information on our system in line with our privacy policy. Please do not share anything sensitive with us if you would not want us to store it.
  • Please confirm that you have read and understood the Booking Terms and Conditions
  • Please confirm that you have read, understood and answered all questions to the best of your knowledge