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Mountain Trek Appalachians Information Form

Please fill out the form below prior to your stay. This information allows us to offer you a highly personalized and transformative experience.

Please note: this form is specific for you and your booking.

Step 1 of 5 - Personal Information

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Booking ID
Name*
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Email*
Phone*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country

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Do you eat the following?
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Red meat
- Yes
- No
Beef
- Yes
- No
Pork
- Yes
- No
Poultry
- Yes
- No
Fish
- Yes
- No
Shellfish
- Yes
- No
Eggs
- Yes
- No
Dairy
- Yes
- No
Tofu
- Yes
- No
Do you have any these common food allergies?
- Dairy
- Eggs
- Peanuts
- Tree Nuts
- Soy
- Wheat
- Fish
- Shellfish
- No food allergies
Please list any other less common food allergies you have:
Do you have any food dislikes? (limit 3)

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Birthdate*
MM slash DD slash YYYY
Gender
- Female
- Male
Height
Weight (lbs)
Emergency contact
Emergency contact phone
Doctor name
Doctor phone
Doctor approval
Current medication
Are you afraid of heights?
- Yes
- No
Do you get car sick?
- Yes
- No
Medical History
Please check all that apply
- Elevated blood pressure
- Elevated cholesterol
- Family heart disease
- Smoke cigarettes
- Kidney disease
- Angina
- Palpitations
- Shortness of breath
- Heart attack
- Stroke
- Dizzy spells
- Peripheral vascular
- Arterial bypass
- Beta blockers
- Angioplasty
- Lung problems
- Neck or back pain
- Joint issues
- Pollen allergies
- Dust allergies
- Depression
- Anxiety
- Mood swings
- Hearing problems
- Vision problems
- Epilepsy
- Type 1 diabetes
- Type 2 diabetes
Do you have any communicable diseases?
Are you allergic to down?
- Yes
- No
Other conditions or notes about your health
What are your goals during your stay?

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Do you have your travel plans booked?*
Remember: Please arrive at the lodge before 5pm on Saturday
- Yes
- No
Email guestcare@staging.mountaintrek.com if you have any questions about travel. We will ask for your travel plans again prior to your arrival so we can plan accordingly.
Arrival*
- Greenville Spartanburg (GSP)
- I am driving to the lodge
- I have other travel arrangements
Flight Arrival Date*
MM slash DD slash YYYY
Flight Arrival Time*
Flight Arrival Airline
Flight Arrival Number*
Flight Departure Date*
MM slash DD slash YYYY
Flight Departure Time*
Flight Departure Airline
Flight Departure Number*
Driving from:
Other Travel Notes

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Would you like to request any extra massages for your stay?
Three therapeutic massages included with your stay but you can request up to 3 additional
- Yes
- No
- Not at this time
You will see a link to add extra services in follow up emails to come. You can also email guestcare@staging.mountaintrek.com at anytime to add services to your stay.
Please note: scheduling is based on specialist availability and therefore cannot be guaranteed. We will do our best to accommodate all extra service requests. Prices do not include tax.
Swedish Therapeutic Massages
Support your individual healing needs with a therapeutic massage. Engage your mind and body, while focusing your session on chronic areas of contraction or pain, while releasing muscle knots and fascia, liberating joints and mobility. $135 USD

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