Guest Accessibility & Medical Requirement Form

To ensure your holiday is as seamless and comfortable as possible, we would like to ask you a few questions about any medical conditions or mobility requirements. This helps ensure appropriate arrangements are in place throughout your journey.

To ensure the comfort and safety of all passengers travelling, who in your party has specific medical, mobility requirements?

First Name

Last Name

Booking/Quote Reference

Dietary Information

1. Dietary Preferences

1. Do you or any member of your party have specific dietary preferences or requirements? (e.g. vegetarian, vegan, halal, gluten-free, dairy-free)*

1. Dietary – If yes,

2. Food Allergies or Intolerances

2. Are there any food allergies or intolerances we should be aware of to ensure your safety and comfort?*

2. Dietary – If yes,

Dietary – Additional Information

Medical Requirements

3. Medical Considerations

3. Do you or anyone in your group have any medical considerations we should be aware of to better support your stay? ( e.g. refrigerated medication, CPAP machine)*

3. Medical – If yes,

Medical – Additional Information

General Mobility Information

4. Mobility Aids

4. Does the guest use or require any mobility aids or medical devices while travelling? (e.g. wheelchair, walker, cane)*

Equipment Type

Equipment Specs

Dimensions

Weight

Battery

5. On and Off Transport without Assistance

5. Are you able to get on and off a flight, coach, minibus, or cruise without assistance?*

Special-Adapted Transfers Needs

a) Are special-adapted Transfers needed?

Airport Assistance

b) Is airport assistance required at the airport?

6. Comfortable sitting in vehicle

6. Are you comfortable sitting in a vehicle for extended periods (up to 3–6 hours)?*

7. Spend 1-2 hours outdoors in hot weather

7. Can you spend 1–2 hours outdoors in hot weather with strong sun exposure?*

8. Visual or hearing difficulties

8. Do you have any visual or hearing difficulties we should be aware of?*

Mobility – Additional Information

Accommodation ( Hotel, Rail & Cruise)

1. Accessibility room or cabin required

1. Does the guest require an accessible/mobility room or cabin? (Subject to availability)*

2. Bathroom preference

2. Bathroom preference*

3. Upper bunk bed access

3. For cabins with bunk style beds, can at least one member of the party access the upper bunk?*

Accommodation – Additional Information

Walking & Terrain

1. Walk unaided for 1-2 hours

1. Are you able to walk unaided for 1–2 hours with short breaks?*

2. Walk 1-3km at steady pace

2. Can you walk distances of up to 1–3 km at a steady pace*

3. Difficulty on uneven surface

3. Do you have difficulty walking on uneven, cobbled, or slippery surfaces?*

4. Up and down stairs without assistance

4. Are you able to go up and down stairs without assistance?*

5. Comfortable for short periods without seating

5. Are you comfortable standing forshort periods when seating is unavailable?*

Walking & Terrain – Additional Information

Acknowledgements

Confirmation

Yes I can confirm the information provided above is correct & accurate to my condition*

Form Complete – Name

Name*

Form Complete – Date

Date of Completion*

* Required Field

Thank you