Book - Les Thermes - Saint-Gervais Mont-Blanc

Title*
MrMrs
Surname*

First name*

Email*

Telephone number

Mobile number

Date of birth*

Adresse*

Postcode*

City*

Treatment paid for using health insurance funds?
YesNo

I accept that my health details below will be processed by Les Thermes Saint-Gervais for the purposes of organising, dispensing and administrating treatments. Learn more about how your details are stored.

Treatment dates

First day of treatment*

You can start your treatment any day of the week.

Please note: Treatments funded using health insurance must take place over 18 consecutive days (excluding Sundays).

Type of treatment

Main treatment*	18 days	12 days	6 days
Dermatology	Dermatology 18 days	Dermatology 12 days	Dermatology 6 days
Respiratory tract	Respiratory tract 18 days	Respiratory tract 12 days	Respiratory tract 6 days
AMB	AMB 18 days	AMB 12 days	AMB 6 days

Additional spa treatment (2nd referral)	18 days	12 days	6 days
Dermatology	Dermatology 18 days	Dermatology 12 days	Dermatology 6 days
Respiratory tract	Respiratory tract 18 days	Respiratory tract 12 days	Respiratory tract 6 days
AMB	AMB 18 days	AMB 12 days	AMB 6 days

In addition to the treatment (not covered)

VIVA programme (post-cancer)Tinnitus treatmentPost covid treatment

Prescribing doctor

Prescriber number

Surname

First name

Address

Postcode

City

Previous treatments at Les Thermes de Saint-Gervais Mont Blanc

Number of treatments completed

Year of last treatment

Summer shuttle (surcharge) from June to September

YesNo

Address of your accommodation during the treatment

Label

Address

Postcode

City

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Thermal Treatment Registration