Botanic Sanctuary Antwerp Health Questionnaire
Botanic Sanctuary Antwerp Health Questionnaire
Signet Botanic Sanctuary Antwerp

Health Questionnaire

Health Questionnaire

Botanic Health Spa

Heal your spirit, free your mind, change your lifestyle, explore nature and feel reborn … at the Botanic Health Spa in Antwerp. We are delighted that you have booked a spa treatment with us. We kindly ask you to fill out our health questionnaire at least 24 hours before your treatment. We suggest that you arrive for your appointment at least 30 minutes prior to your treatment time so that you can relax, unwind and enjoy your unique Botanic Health experience to the full.

    First Name*

    Last Name*






    Country *

    Date of Birth*




    Please give details


    Have you recently received a treatment?*

    Is something bothering you at the moment?*

    Date of last operation*

    Have you experienced any emotional changes lately?*

    Do you wear contact lenses?

    Do you suffer from any of the following?

    Please give details

    Are you taking any medications and/or supplements?

    Please give details

    How do you like your massage pressure?

    Are there any areas on your body you would like us to avoid?

    What do you expect to get out of your treatment at the Botanic Health Spa?

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