Travel Experience Booking Form

Personal Details
Traveler Contact Info

First NameLast Name
Contact Number

Area CodePhone Number
E-mail
Preferred Method of Contact (email/text/phone)
Travel Details
Preferred Travel Start Date

MonthDayYear
Date
Preferred Travel End Date

MonthDayYear
Date
Are you Interested in: (Select all that may apply)

Free 5 Minute Wellness Screening by our wellness clinic partners (for below)Using FSA/HSA Benefits for your TravelSeeing If this Trip can be deemed as Necessary for your WellnessPossible Tax SavingsI am Not Interested in Possible Savings on my Experience/Trip
Preferred Destination(s)
Ex: US, Europe, Canada, New Zealand, Asia
Type of Wellness Experience you're interested in (select all that applies)

Access to Spa & RelaxationYoga & MeditationNature & AdventureDetox & NutritionFitness & ActivityFun By the SeaOther Experience (below)Other
Purpose of Travel (select all that applies)

Wellness RetreatCME OpportunityCorporate TripGroup TripSolo TripOther
Guests

(Put N/A if Not Applicable)
Total Number Of Adults
Adult Names
Total Number Of Children
Children Names
Accommodation Preferences
Preferred Lodging
If Unknown, Type "unknown"
Special Occassion
Number Of Rooms
Adult Only Or Kid Friendly
Room Type

SingleDeluxeDoubleSuiteTripleAccessibleVillaOther
Cabin Type (If Applicable)

Inside CabinOutside CabinPreferred Cruise Line (below)Other
Porting From (Cruises)
Transportation To And From Hotel
Dietary Preferences (select all that applies)

VeganVegetarianGluten FreePlant Forward/MediteraneanOrganic/Grass fed/Wild CaughtOther
Activity Preferences

SpaGolfArcheryScuba DivingGymTennis/pickelballYogaZiplineJet SkiGuided Walks/hikesMeditationOther
Estimated Trip Amount (US Dollars)
If no Budget amount, type "No Budget"
Include Travel Insurance
Payment Selection
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Should be Empty:

Personal Details

Travel Details

Guests

Accommodation Preferences