Your Name 

 Email

 Spa Menu (Please provide your preferred treatment) 

 Desired Date of Spa
Select Month 2024/October 2024/November 2024/December 2025/January 2025/February 2025/March

 
Date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

 Start Time
Select 09:00 09:30 10:00 10:30 11:00 11:30 Any Time (Morning) 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 Any Time (afternoon)

 No. of Guests
2 people 1 person 3 people 4 people 5 people 6 people

 Form of Payment
Charge to Room (in-house guest only) Credit Card Cash in Indonesian Rupiah

 Nationality

 Mobile/WhatsApp Number

 Room Number (and Hotel Name for outside guests)

 Request / Message (if any such as additional treatment)

If there is no response after tapping once, please tap it again to confirm your request on the next screen.