ENQUIRY FORM                                           Residential Health Packages and Services

This inquiry form should be completed for all residential programmes offered at Manna House Health Education & Wellness, including overnight and short stays and other services. Note this form is an expression of interest and no payment should be made till confirmation from Manna House of acceptance onto a programme or service. 

Room or Package Preference

Do refer to the Product Range and website before making your decision. Please indicate your package or programme preference i.e, Refresh or Restore or kickstart, bed and breakfast etc. Please be advised that any existing health challenges require the Restore package as therapies are included in the price.

Payment Information

The inquiry form acts as an expression of interest in attending a programme and no payment should be sent until confirmation is given you from Manna House that you will benefit from the programme. Upon acceptance to a programme a non-refundable deposit of 50% of the total cost is due to secure your booking and the remaining balance is due 10 days before the programme commences.

We prefer bank transfers. At Manna House we can received card payments but prefer bank transfer due to card payment charges. If you wish to pay by cheque, please contact Manna House to discuss how this should be done.  Be aware that your booking will only be confirmed once your funds have cleared our bank. Packages are priced on a “payment-in-full” basis due 10 days before you arrive. We are unable to accept health guests on any package until payment has been made in full.

For other services such as the Health Consultation, Body Chemistry Review, Lifestyle Protocol, massages and other services payment is made in full at booking.

Refunds

The deposit paid at time of booking is non-refundable. As an exception, refunds are given ONLY in the case of an emergency which means you cannot come due to circumstances that are out of your control such as serious injury, hospitalisation, death, or cancellation on our part. The refund will be less an administrative charge to cover bank costs and any other administrative expenses that are incurred during the booking process. 

If you cannot come due to reasons that are NOT an emergency, you may transfer your deposit to a future programme. Transfers are valid for up to 1 year effective from the dates they originally registered for. If you choose not to attend 10 days before a package commences you will forfeit 50% of the deposit with only 50% remaining for a future payment towards a programme. As such an additional 50% will need to be paid to confirm your place on a future programme. 

Additional Costs

The product range and website or discussion with the staff for what is included in your package. The Restore packages includes therapies but does not include: 

  • Equipment e.g. enema bag, bulbs, eye wash cups etc 

Any additional costs will be explained to you. If you receive extra therapies (The Refresh Package), it is with the understanding that you will pay for them by conclusion of the programme. For the Restore Package therapies are determined by your health condition(s) based on the individual health needs assessment, consultation and daily body chemistry analysis and health guest’s request. 


Health Education & Wellness 

Please note that Manna House is a wellness centre and does not provide personal care. If you require personal care such as dressing, bathing, showering, mobility support, supervising medications, feeding etc then you should consider bringing someone with you to support your care needs. Manna House does not operate 'care home' facilities.  If information regarding additional health conditions and personal care needs comes to light during your stay which may put extra pressure on our services then we would be at liberty to terminate this agreement. 


Disclaimer

A disclaimer will  be sent to you prior to booking your place on the programme. This needs to  be signed and returned 10 days before programme commencement.


Please complete one form per health guest.

8 Days (7 nights) Residential Programme Package & Prices
11 Days (10 nights) Residential Programme Packages & Prices
Price List
PERSONAL INFORMATION
First Name
*
Last Name *
Date of birth. *
What is your current age? *
Please state your gender/biological sex *
Address including postcode
*
Mobile telephone number *
Email address
What is your ethnicity? *

Emergency Contact Details

Please include: 

Full name, Relationship to you, Address:

Contact number:

Email address:

*
What is your weight in kgs? *
What is your height in cms?
Hip waist ratio
How much does your waist measure in cms?
Hip waist ratio
How much does your hips measure in cms?

State all health concerns. 

Please note that we may not be able to address a health condition if it has not been stated on the registration form.

*

State all medications & supplements. 

We recommend that you discuss with your medical provider your health and medications before attending a residential programme.

Did you take the covid 19 vaccination? *
Required
If yes, how many injections have you had?
Female: are you pregnant?
Clear selection

Do you have an allergy?

*

If yes, please state the allergen

Do you have a faith or follow a religion?
Clear selection
If the answer is yes, please state what is your faith or religion.
SOCIAL HABITS

1. What time do you wake up?
2. What time do you have your first meal/breakfast?
3. What time do you have your next meal?
4. What time do you have your last meal before bed?
5. What time do you go to bed?
6. Do you have snacks?
7. Do you eat meat or dairy products? 
This includes any animal and fish, milk, cheese and eggs
Please provide any other additional information about your health and special requirements that you consider relevant.

I am interested in:  

Please check those that applies

*
Required

I am interested in attending the Restore to Health, Refresh or  other (please state) residential Programme that begins on  (date):__________________________               and finishes on date:___________________________________

Please state dates of the package and how many nights 
I will be sharing a bedroom suite with (name of companion).
How did you hear about Manna House Health Education & Wellness? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy