Panchakarma Reservation Form

Deposit Requirement: A 50% deposit is needed to confirm your booking. Acceptable payment methods include VISA, Mastercard, or bank transfer. This deposit must be made within 7 working days of receiving your booking confirmation.
Deposit Refund Policy: Refunds on deposits are not available. However, in case of changes to your plans, up to 100% of your deposit can be applied to another retreat, to be used within 12 months of your original Panchakarma date. Cancellation penalties may apply.
No Credit for Unused Services: Credits are not offered for late arrivals or early departures. Additionally, no partial refunds are available for any services not utilized during your Panchakarma stay.
Agreement to Policies: Your payment indicates acceptance of the Rudra Sahashrara Bali Participants Disclaimer and our Privacy Policy.

Room Type*
I want to book Panchakarma for*
What date would you like to start?*
Please note—the first four days of the menstrual cycle can interfere with detox treatments, please consider this when selecting your dates.
YOUR PERSONAL INFORMATION
Title*
First name*
Last name*
Country of Residence*
Email*
Phone*
WhatsApp number*
I use the same number for WhatsApp
Have you done Panchakarma before?
Yes
No
Do you have any serious health issues or recent surgeries?*
Yes
No
IMPORTANT: If you have any existing health issues or have had recent surgeries, please let us know as our Ayurvedic Physicians will need to assess whether you can safely do a Panchakarma (Ayurvedic detox) before your arrival.
Special Request
How did you hear about us?*
Participants Disclaimer
Privacy Policy
I have read and agree to the Retreat Participants Disclaimer and Private Policy
PAYMENT INFORMATION
Voucher code (optional - valid discounts will be applied to your balance payment)

+62 812 6000 3436

Need more information? Give us a call.