Passenger Full Name Lead passenger on booking Do you need wheelchair assistance?If you are travelling unaccompanied, you must be able to self-evacuate and attend to your own toilet needs. Yes No Can you walk without assistance? Yes No Please provide details, including how far you can comfortably walk unaided and any walking aids you use.Are you able to walk up and down the aircraft stairs without assistance? Yes No Are you able to walk from the aircraft door to your seat? Yes No Do you require any assistance with vehicle transfers? Yes No Please let us know about the assistance you require with transfers...Are you planning on travelling with your own mobility device? Yes No Please give details of the device (manual/ electric, model number, collapsable etc).Do you intend of bringing any additional medical luggage? Including any walking aids. Yes No Please provide details of additional medical luggage you intend to bring.Do you require any assistance or medical equipment at your accommodation? Yes No Please let us know what type of assistance or medical equipment you may require.Do you have a significant visual impairment we need to know about? Yes No Please let us know what type of visual impairment(s) we need to aware of.Do you have a significant hearing impairment we need to know about? Yes No Please let us know what type of hearing impairment(s) we need to aware of.Do you need an assistance dog or harness onboard? Yes No Do you have any medical condition that affects any major organs? Yes No Please let us know more information about your medical condition and how it may affect your trip.Do you have any medical condition that affects your breathing, including the use of oxygen? Yes No Have you had a cancer diagnosis? Yes No Please provide details, including date(s) of diagnosis.Are you currently undergoing any treatment for cancer including radiotherapy or chemotherapy? Yes No Please provide details about your treatment.Do you have a hidden disability? Yes No Please provide details of your disability.ConsentConsent(Required) I am happy for Gilly Bachelor Travel Expert to share the above information with my holiday provider and all other necessary parties.(Required)Consent(Required) I will inform Gilly Bachelor Travel Expert should circumstances change.(Required)
