Sign Up for a Biomental Botinnox-treatment by fax:

Please fill out the remaining fields and simply print out this page to your desktop printer and send it as fax to 0049 3222 3946830. To order a hotel, please click on hotel. For our adress please click on adress. The treatment begins monday at 10.00 a.m. and ends friday at 13.00. For the 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
Adress (Street, Nr.)
City
Country
Phone-Nr.
Date of birth
E-mail:

I hereby sign up for a Botinnox-treatment (5 days-relaxation and activation of healing-reflexes à 60 minutes consisting of optical and acustical respiratory biofeedback, light- and soundtherapy and videotherapy additional one Botox-injection each day). I have reserved the treatment by phone (+49 2132 9958996) for the following days:


At the same time I have transferred 1500,- Euro to the account:

Dr. Hans Greuel
Deutsche Bank
Kto.-Nr. 0460501
BLZ: 30070024
IBAN:DE93300700240046050100
BIC: DEUTDEDBDUE


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