Health Questionnaire

Thank you for booking with Anahata. In order to give you a better and more personal experience, we need to kow some important things about your health and food habits. Please fill up the details in this form so that we can get to know you better.

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Returning Guest?
Relationship Status
Have you ever been hospitalized?
Have you ever detoxed before?
Do you have any serious injuries or ailments?
Do you take any supplements or medication?
Do you have any allergies or sensitivities?
Have you had any abdominal surgery in the past 12 months?
Do you have or experience any of the following:
Do you have any children?
Please select your cravings, if any:
Do you suffer from any of the above Colon Cleansing Contraindications?
Do you suffer from any of the above Full Fast Contraindications?
I confirm that I have read the Anahata Wellbeing Resort Terms and Conditions policy agreement and agree to all conditions set forth without exception. I also confirm that the information I have provided is correct to the best of my knowledge. By ticking the confirm box, I am agreeing to the equivalent of an electronic signature stating that

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