30, rue des Lazaristes - BP 278
40106 Dax Cedex France 
Tel : 05 58 74 86 13 - Fax : 05 58 56 92 43
  eservation
For simple registration and a better welcome at Borda Thermal Spa, please fill in this reservation form, detailing the therapies prescribed by your doctor.

Details of the spa guest(s)
Number of persons *: * Required information
Mr. Mrs. Miss Mr. Mrs. Miss
Name *
First name *
Address *
Postcode *
Town *
Phone number *
Portable phone
Name
First name
Address
Postcode
Town
Phone number
   

Type of stay
For the first person: For the second person :
SS Thermal cure (18 consecutive days of treatments) : SS Thermal cure (18 consecutive days of treatments) :
Rhumatology only (RH) : Rhumatology only (RH) :
Phlebology only (PHL) : Phlebology only (PHL) :
Double orientation (RH and PHL) : Double orientation (RH and PHL) :
Introduction health stay (6 consecutive days) : Introduction health stay (6 consecutive days) :
Free cure (your choice of length of stay, minimum 3 days) : Free cure (your choice of length of stay, minimum 3 days) :

Period requested from: to: or from: to:

Type of accommodation
On the Thermal Bath site: Other accommodation:
- "Demeures de Borda" residence:
- "Terrasses de Borda" residence:
- "Thermale de Borda"residence: 		- Please specify:

Thank you for contacting us.
One of our receptionists will contact you in under 24 hours to validate and confirm your booking.

I agree to receive, by e-mail, information from your company.
         

In accordance with the Loi Informatique et Libertés of the 6 January 1978 (the Computer and Freedoms law), you have the right to access and rectify any personal information pertaining to you.

Our company or association remains the sole receiver of any information sent to its attention.