Sign Up for a Botox-treatment by e-mail:
Please fill in the empty address fields, print the form, sign and mail or fax it to +49 2132 9958993. To order a hotel, please click on hotel. For our adress please click on adress. For the accompanying Biomental Training in your hotel you need a mp3 player or a GSM with an email account or a PC and an USB-stick and headphones.
First name:
Last name:
ZIP:
City:
Street no.:
Email-adress:
Phone-No.:

I hereby sign up for an Botox-Treatment (5-days biomental relaxation plus one Botox-injection each day). I have reserved the treatment by mail (dr@hansgreuel.com) or phone (00492132 9958995).

At the same time I have transferred 1530,- Euro to the account:
Dr. Hans Greuel
Deutsche Bank
IBAN:DE93300700240046050100
BIC: DEUTDEDBDUE

I agree with the privacy agreements.

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