Contact Information

  • This form is for all of our retreats at Loxley House in the Midlands, KZN. Make sure that you have completed every section of the booking form before submitting it. Entries which display an asterisk * are required.
 

Accommodation and Prices

  • Please note that each person booking needs to submit a separate booking form and health questionnaire.
 

Dates required:

  • If the retreat week you would like is shown as fully booked, let us know if you would like to go on the cancellation list as places often become available at the last minute.
 

Detox Programme Health Questionnaire

 

Medical History

  • Please make a list of all the health problems that you would like to clear up and indicate how long you have had these problems (eg. headaches - 7 years). Please start at number 1 with the problem of the longest duration, ending with the problem that occurred most recently.
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    By submitting this form...

    I consent to treatment involving the application of Naturopathic Therapies.

    I hereby acknowledge that I have agreed to receive a naturopathic therapy of my own free will and without any coercion or undue influence.

    I acknowledge that naturopathic therapies for any disease or chronic condition do not guarantee a cure or remission from my illness.

    I acknowledge and agree that my own doctor and any specialist consultants will remain responsible for my general medical care throughout the period of application of the naturopathic therapy, and that the Detox International team and its professional staff will act in an advisory capacity only.

  • CONTACT IN CASE OF EMERGENCY:

  • DOCTOR'S DETAILS

 
 
 
 
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    Important Information Page

    Payment Terms and Conditions Page

  • If you would prefer to pay in US$, please contact us for the current exchange rate and payment details.

    Please note: Cheques are payable to 'Detox International Ltd.', thank you.

    Email: info@detox-international.co.za
    Tel: +27 (0)84 571 8018.

 

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