CASA TERRA REGISTRATION THE AMAVEDA PANCHAKARMA AT CASA TERRA Full Name*Email* Telephone/WhatsAppPlease include + area codeAgeWhere do you live?How is your overall health? Under doctors supervision With some health issues Average Above average Room Choice TERRA - BOOKED AZUL - BOOKED MADIERA - BOOKED ALFARROBEIRA - BOOKED POENTE - BOOKED NACENTE - BOOKED JARDIM - BOOKED 4 BED ADJACENT VILLA If not available we will let you know what rooms remain open. HEALTH ISSUES-Please list any illnesses or health issues. Make sure to list all present medications and or treatments. What level is your yoga practice? Beginner Occasional yoga class As often as possible Dedicated practice I am a yoga teacher GOALS-What would you like to accomplish by attending this program?Payment preferenceMillennium Portugal Direct depositAny Credit Card + 2.9%How did you hear about the Amaveda retreat?Please let me know your referral if you have one. The Amaveda detox program is for educational purposes and is not intended to treat, cure, mitigate or prevent any disease. Any participant with a serious medical condition or taking prescription medication should check with their health care practitioner before following the detox program. The physician who has prescribed any medications you are taking must be aware of your intention to follow a detox program. I have read the above statement and agree to take full responsibility for any results this program may incur.* I have read and agreed
