To sign up for a treatment, please fill out the form provided here:

Les Thermes Berot
16, rue Louis Barthou - B.P. 156
40 104 DAX Cedex - FRANCE
Tel.: +33 (0)5 58 90 40 00 - Fax: +33 (0)5 58 90 40 02
E-mail: THB@berot.com

“In accordance with the law of 6 January 1978 relating to data processing, files and liberties, you have the right to access, communicate and modify the data that has been asked of you, and which is necessary for the processing of your order. This information shall remain confidential, it shall not be disclosed to any third party. No data exchange by virtue of file cross-referencing will be executed”.
Client N°  
Exact dates of your treatment : from  
To  
Type of therapy  
SURNAME *
First name  
Adress *
Telephone  
Date of birth  
E-mail *
How will you be arriving in Dax ?  
Name and address of your attending physician  
Will you use the minibus?  
Name and address of your thermal therapy doctor  
Your comments  
   
  *Obligatory fields  
Les Thermes Berot - 16, rue Louis Barthou - B.P. 156 - 40 104 DAX Cedex - FRANCE
Tel. : +33 (0)5 58 90 40 00 - Fax : +33 (0)5 58 90 40 02 - E-mail : THB@berot.com
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