Your Name (required)

Your Email (required)

Enter your address (please include City, State, Postcode)

Enter Your Website

Enter Your ABN/ACN

Criteria

What is your facility?

Drug Rehabilitation CentreAlcohol Rehabilitation CentreHolistic and Wellness RetreatWeight Loss camp

Please select which apply to your faciliy

Air conditionedGymPoolSaunaWi-FiIs smoking allowedFree on site parking

Please Enter Payment Options

Facility full feeHealth funded subsidized

Enter Minimum Stay Period

Enter Maximum Stay Period

Enter Price Per Night / Week (please specify) - please also specify check in / check out times

Consent Images
Please tick to consent your initial profile image being obtained from your website (as above) - Please note that you can edit this image and add additional after account creation.
Please enter any other relevant information

Please upload photos (minimum 2 photos are required)

Please enter your Name and Date

Date

We will reach for additional images to upload after the initial registration

Consent
Please tick to consent to your data being stored in line with the guidelines set out in our Terms and Conditions