This form is for your room availability request. Your reservation process must be done and completed by e-mail with our reservation department. Please complete the following form with all the information you have about your trip, your procedures, the doctor/surgeon of your choice and any other questions you may have. Once we receive this form, we will respond with our availability.

Name*:

Email*:

Arrival Date*:

Departure Date*:

Number of Guests:

Room Type Preference:

Airport transportation:
YesNo

Anticipated Medical Procedure(s):