Resort Health Profile - Lake Austin Spa Resort

Guest Name

Birth Date

Gender

Male
Female

We respect your unique health needs and concerns. If you require activity program modifications due to a medical condition or limitation, please let us know so a member of the staff can contact you.

Please check all that apply:

If you checked any of the boxes above, please describe:

NOTE: If you have food allergies, please tell your server(s).

Person to contact in case of emergency:

Name

Phone Number

Smoking policy – In the interest of health, Lake Austin Spa resort is a non-smoking facility. We ask that you please refrain from smoking inside any building, including your room. For your convenience, ashtrays can be provided for your use in your garden. To keep smoke from entering your room, please make sure all doors and windows are closed while you are smoking. Removing smoke odors from a guest room following departure will result in a $1000 late charge for the Lady Bird Johnson Suite and a $500 late charge for all other rooms. We appreciate your cooperation.

I, the undersigned, affirm that the above information is true to the best of my knowledge. I further affirm that I have disclosed all medical information and am able to participate in an active program.

Signed

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