Individual trip enquiry form

Please be kind enough to fill the form below so we can serve you better.

Your Individual Trip to the Philippines is Booked

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

Gender*

Year of birth*

Email Address*

City

Country*

Cell Phone Number including country code*

Are you on WhatsApp?*

How many of you are coming?*

Next of kin name, phone number and email address to contact in case of emergency:*

Day & Time of arrival*

Return Flight Date, Time & Number*

Are you bringing a wheelchair?*

How many of you intend to have a consultation?*

If having a consultation, what are Visitor 1 Health Concerns? List them in order of importance and explain what treatments / drugs / natural remedy you have used for them

If having a consultation, what are Visitor 2 Health Concerns? List them in order of importance and explain what treatments / drugs / natural remedy you have used for them

Confirm your acceptance of our Agreement form on behalf of ALL travelers. Link: www.therapies.com/agreement.html *

	I/we have read it and we ALL agree to its terms
	I/we have not read it but agree to it anyway

How did you hear about our trips?*

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