SERENITY Just for You program

We want your experience at Serenity Inn & Spa to be all that we can make it.
Please complete this questionnaire and we will design a
package of accommodation, meals and services
Just For You.

The information provided on this form will be used in strict confidence.

Name:
Address:
Suite/Apt/Floor:
City:
State:
Zip:
Phone:
Email:
Referred by (if appropriate):
Preferred contact method:
Best time to reach you:
Perferred Arrival:
Preferred Departure:
Are your dates flexible?	Yes No
How many guests in the party?:
How many beds will be needed?:
Please indicate your room preferences:	Standard Room(s) Deluxe Rooms(s) Suite(s) Please quote package with all options
Would you like to include a full meal plan?	Yes No (if selected, you will have breakfast only)
Please indicate the goal for your visit. (Check all that apply)
Relaxation and stress reduction Greater wellness Experience Spa services Spiritual renewal On the road to better nutrition and weight management
Please add any additional comments that will help us understand your goals for this visit:

*Services you are interested in receiving*: (Check all that apply)
Skin treatments Massages Healing services for pains and other physical problems. Nutritional counseling Personal counseling Spiritual counseling
Please add any additional comments that will help us understand your treatment selections above:

*Other activities*: (We may be able to arrange the following. Check all that you would like included in your program.)
fishing golf antique hunting museums
Budget Amount:	Indicate a dollar amount, if you would like us to work within a budget.
If you have any other comments, please add them here: