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USR Booking Form - up to three people for £123 (inc.)

Now, up to three unrelated people can share the price of £123 between them to each
receive a U.S.R. This 'Club Booking' agreement is available for a limited time only. If you wish to book a single U.S.R, please ignore the pink and blue fields in the form below.

Terms and Conditions apply: All parties must be aware of the booking of their U.S.R; acknowledge the date and time of the treatment; and that the U.S.R. preparation practices are understood.

Please allow 24 hours for your order to be processed and acknowledged.
A booking confirmation email will be submitted to the email address provided.

* How may people wish to have a USR?: -

* Your Name: -

Your Occupation -

* Your Town / Location: -

* Your Email Address: -

* The Date for Healing: (@ 8pm G.M.T.) -

Do you have any medical conditions?: -

Where did you hear about us?: -

Second person to have a USR: -

Second persons Town/Location: -

Third person to have a USR: -

Third persons Town/Location: -

* Do all parties acknowledge the Date and Time?:

Yes

* Do all parties agree with the Terms and Conditions?:

Yes

Any further Comments?: -

And... enter the digits below: (hit 'refresh' if necessary)

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