Reservation Form

At  A Cozy Break, we operate on a reservation-only basis to ensure you have a fully relaxing experience. Please use the form below to select your preferred date, time, and treatment course.


Reservation Guidelines:

• Please make your reservation at least 3 hours before your desired start time to allow for preparation.

Example: For a 2:00 PM session, please book by 11:00 AM.

• Responses may be delayed during treatment sessions. We appreciate your understanding in advance.

Name *
Mail *
Phone number *
Age *
Gender *
Date and time

• Please enter the time as well.

• Providing a second preferred date and time will help ensure a smoother booking process.

*
first time or Repeat *
Course 
*
Treatment Locations *

Inquiry:

• If you are booking a home visit, please provide the nearest station.

• If you have any questions or concerns, please feel free to contact us.

*
Cancellation Policy

• Please notify us as soon as possible if you need to change or cancel your reservation.

• A cancellation fee may apply for same-day cancellations.

• No-shows may inconvenience other customers, so we kindly ask you to avoid them.


I agree to the terms of service *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report