This form is only for your room availability request. Your reservation process must be done and completed by e-mail with our reservation department in order to keep the necessary records. Please complete the following form with all the information you have about your travel, your procedures, the Dr. of your choice and any other question you may have, once we receive this form we will be writing back to you. Please be sure to indicate your correct e-mail address below.

Your Name (required):

Your Email (required):

Arrival Date (required):

Departure Date (required):


Room Type:

Shuttle Request:

Anticipated Medical Procedure(s):