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Treatments order form

Dear guest

Please indicate person's name who receives treatment, name of treatment requested, requested treatments dates, and whether you prefer to be given the therapy from man or woman.

Also possible to choose additional treatments in addition to the treatment you already chose.


Name of the requested treatment:
Guests name preferred day and hour type of therapist price
Man
Woman
 
    Total  
 
Family name     Health limitations
First name
Name of person accompanied Health limitations
of person accompanied
E-mail address  
Number of room reservation Check in date to Gallery Hotel
Phone number cell. No
Fax    
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61 Herzl Street, Haifa 33504 Israel Tel.: 972-4-8616161 Fax: 972-4-8616162 http://haifa.hotelgallery.co.il gallery@hotelgallery.co.il
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