Health & wellness is as individual as you are

Your Med-Spa questionnaire

It really is lovely that you want to take time for you and for your health. This journey to a new physical feeling begins with one small step – our Med-Spa questionnaire. Find a quiet moment, get comfortable and complete the Med-Spa questionnaire as fully as possible. Using the information you provide, our Med-Spa team will be able to glean key information beforehand to be able to provide supportive advice on health & wellness even before you get to our health hotel.

Your confidential details will be encrypted and treated with the utmost discretion.

We are here for you at any time should you have any questions about health & wellness. Give us a call on +39 0474 670 230.

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Please enter the dates of your holiday.

Guests

Date

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Primary Questions

What health problems, pain or problems are you currently suffering? *

What changes and improvements to your lifestyle would you regard as being superficial? *

What does health mean to you? *

How and where do you envisage your future? *

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Medical questions

Have you have any previous illnesses, infections or operations. What? When? *

What medication are you currently taking? What treatment attempts have you undergone in the past? *

Are you aware of any allergies and/or intolerances? *

State your age, weight, height and waist measurement. Have you noticed any changes in your weight recently? *

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Questions regarding complementary medicines

Unhealthy habits

What other wishes do you have? What is important to you or do you have anything else you want to share with us?

Privacy

By sending the request form, you agree to the data processing procedures and storage for future information purposes as stipulated in the Data Protection Act (d. lgs. n. 196/2003, Art. 13).