Veterans Pre Check In First Name *Please enter your full government nameMiddle NamePlease enter your full government nameLast Name *Please enter your full government namePhone Number *Date of Birth *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeArrival and departure date? (We have your flight information, this is to confirm) *Do you have allergies? *Select the best optionYesNoWhat allergies? *Do you have dietary restrictions? ( ex: no pork, vegetarian, ect ) *Select the best optionYesNoWhat dietary restrictions? *Do you have any mobility restrictions? *Select the best optionYesNoPlease describe any condition that may affect your mobility, including difficulty using stairs, walking long distances, standing for extended periods, balance issues, wheelchair/walker use, recent surgeries, knee/back pain, shortness of breath, etc. *Please note: The Maple Suites Clinic is currently located on the 3rd floor and does not have elevator access at this time.Veterans who report mobility restrictions may have their appointments scheduled at Las Flores Hotel, where elevator access is available, to provide a safer and more comfortable experience.Transportation to and from appointments is included.If you are staying at Maple Beach: Are you comfortable going up and down stairs for appointments at Maple Suites Clinic? *Select the best optionYes, I am comfortable using stairs and prefer appointments at Maple Suites Clinic.No, I would prefer appointments at Las Flores Hotel due to elevator access.I can use stairs if necessary, but I prefer Las Flores Hotel if available.Consent *I understand that appointment locations may be assigned based on mobility and accessibility needs to ensure the safest and most comfortable experience possible.Do you have a sleep apnea machine? *Select the best optionYesNoAre you bringing other devices that need a certain accommodation? *Select the best optionYesNoWhat device? *Do you have any medical condition that is not stated in your disability breakdown letter that we should be aware of? *Select the best optionYesNoWhat is the medical condition(s)? *Do you have special requests?Are you bringing a guest? *Select the best optionYesNoI don't know yetPlease provide your guest's name and age: *If you are traveling with a guest, please select your preferred sleeping arrangement: Please note: Room configurations vary by property, and separate sleeping arrangements are limited and subject to availability *Select the best optionWe are comfortable sharing one bedWe would prefer separate sleeping arrangements if availableA 200$ hold will be placed on your card at check in as a security deposit for your room. It will be released after check-out. DO YOU ACKNOWLEDGE AND AUTHORIZE THE TEMPORARY 200$ HOLD ON YOUR CARD? *Select the best optionYesNo ( If this option is selected, we cannot provide accommodation )Upload your Passport or Driver's Licence *Choose FileNo file chosenDelete uploaded fileI , , whose signature appears at the bottom of this page, in my name and the name of all the people who stay here with me, hereby relieve the Hotel Las Flores wellness center, from all the responsibilities and any type of claim based on my occurrence related with sports or other activities at the pool, the sea, the beach, floors or other different areas of the hotel, also any occurrence related with my imprudence and lack of precaution that cause any belongings damages of the Hotel Las Flores damages. I also relieve them from any responsibility of all activities which are conducted by concessionaires or licensed companies, or which are due to carelessness toward hotel signs, or which have connections with abuse of alcohol or drugs use or which are connected with money, valuables, jewels, objects or documents that have not been deposited in safety boxes that the hotel provides to its guests.In virtue of this company, Hotel Las Flores wellness center, being Dominican Companies and the services are provided in Dominican Republic, the undersigned agrees to submit all controversies related to services to guests to the jurisdiction and the competence of Dominican courts and hereby renounces expressively all rights of any other court or authority outside the Dominican Republic. By order of the Central Bank of the Dominican Republic, payments must be done in Dominican pesos based on the official exchange rate. I agree to vacate my room (s) by 10:00 am on my check-out date. I accept and I am responsible for all charges made with my RoomKey Credit CardUpon Check Out my account will be settled in this registered credit cardConsent *I accept the terms and conditionsToday's DateSignature *Sign HereYour browser does not support e-Signature field.Submit Real Estate First Name *Last Name *Are you interested in learning more about real estate and investment opportunities in Punta Cana? *Select the best optionYes, definitelyMaybe, I´d like to know moreNot at the momentHave you invested in real estate before? *Select the best optionYes, in the Dominican RepublicYes, in another countryNot yet - I´m exploring my first opportunityWhich type of property interests you most? *Select the best optionLand lots (for building of long-term investment)Pre-construction condosVillas / townhouseCommercial spaces (shops, offices, etc.)I´m not sure yetWhat is your ideal investment range? *Select the best optionUnder $50,000 USD$50,000 - $100,000 USD$100,000 - $250,000 USD$250,000+ USDStill exploring optionsWhat´s your main goal for investing? *Long-term appreciationPassive income / rentalsVacation home for personal useRetirement planGroup or family investmentHow soon are you planning to invest? *Select the best optionWithin 1-3 monthsWithin 6 monthsWithin 1 yearI´m still gathering informationWould you like to see an investment opportunity (Legacy Miches) during your visit (on Sunday)? *Select the best optionYes, absolutely — I’d love to see what’s availableNo, I’m just here to enjoy the tourHow would you like us to follow up with you? *WhatsApp messagesEmailPhone callNo follow-up neededPhone Number *Email Address *Would you like to receive updates about future tours and investment opportunities? *Select the best optionYes, keep me updateNoSubmit Traditional Chinese Medical First Name *Last Name *Prior acupuncture therapy? *Select the best optionYesNoHow do you feel about your current health condition? *Select the best optionGoodFairPoorRecent tests/screenings(eg: blood, x-ray, MRI)?Medications and supplements?Regular exercice? *Select the best optionYesNoSleep Well? *Select the best optionYesNoPregnant? *Select the best optionYesNoTermAreas of pain on your body *Pain on a scale from 1 to 10 ( 1 is less, 10 is most pain )CommentsSigns of inflammation or infectionCurrentPastFamily HistoryTension headaches or migraines.CurrentPastFamily History“Pins & needles” or numbness.CurrentPastFamily HistoryStrength or sensory loss of any kind.CurrentPastFamily HistoryHearing or vision loss, balance/coordination.CurrentPastFamily HistoryCardiovascular disease. Pacemaker?CurrentPastFamily HistoryHigh or low blood pressure.CurrentPastFamily HistoryDiabetes, or other hormone disorders.CurrentPastFamily HistoryBroken bones, artificial joints, pins or plates.CurrentPastFamily HistoryOsteo- or rheumatoid arthritis.CurrentPastFamily HistoryCuts, warts, open sores, skin irritation.CurrentPastFamily HistoryBronchitis, emphysema or asthma.CurrentPastFamily HistoryTuberculosis, hepatitis herpes or HIV.CurrentPastFamily HistoryAllergies, hyper-sensitivities, anaphylaxis.CurrentPastFamily HistoryCancer or auto-immune disorder.CurrentPastFamily HistoryMultiple sclerosis, epilepsy, nerve-disorder.CurrentPastFamily HistoryAnxiety, panic attacks or mood disorder.CurrentPastFamily HistoryOther medical conditions not listedCurrentPastFamily HistoryOther conditionHow do these symptoms affect your recreation, work duties and social interaction?Other therapies/treatments currently receiving?When did the symptoms described begin? Is the pain constant?Do you have any other symptoms associated with this pain?Please mention any factors that relieve it.How would you describe your current emotional state?Today's DateConsent *I understand my information is held private and confidential and released only with my permission or as required by lawSignature *Sign HereYour browser does not support e-Signature field.Submit Hot Stones First Name *Last Name *I confirm that I have been informed about the therapeutic massage procedure that includes temperature variations and the application of hot stones. I understand that this therapy is used to enhance circulation, relax muscles, and reduce stress, but it also carries certain risks and potential side effects. Procedure Information: The massage will include the application of hot stones on the skin and temperature variations in certain areas of the body. Special oils or lotions will be used to facilitate the therapy. The session will be tailored to my individual needs and heat tolerance level. Possible Risks and Side Effects: Intense heat sensation on the skin. Temporary redness or skin irritation. Potential minor burns if the temperature is not suitable. Discomfort in case of extreme sensitivity to temperature changes. Consent Declaration: I confirm that: I have received the necessary information about the procedure and its possible risks. I do not have pre-existing medical conditions that would contraindicate this treatment, such as skin diseases, severe circulatory disorders, or extreme sensitivity to heat. I commit to informing the therapist immediately if I experience any discomfort or adverse reaction during the session. I voluntarily consent to receive the therapeutic massage with temperature changes and hot stones. I understand that I can withdraw my consent at any time without consequences.Signature *Sign HereYour browser does not support e-Signature field.Submit
