Assistance Requirements

As a reputable operator, we would like all of our clients to enjoy completely successful travel arrangements. If you have a medical condition or disability requiring special travel, accommodation, transfer or dietary arrangements, please complete this questionnaire. We will use this information to check the suitability of all components of your itinerary before we issue our confirmation invoice.

In completing and returning this form to us, we understand that you are providing permission for us to relay the information contained to the suppliers of your holiday components, such as airlines, hotels, transfer agents, etc. Some airlines may also require you to complete one of their own medical forms together with notes from your GP.

Please ensure that you provide as much detail as possible and use the sections provided for any additional information which may help us to help you.

Please check that your holiday insurance policy adequately covers any pre-existing medical condition and covers any expensive equipment you may be taking.

* = Required field

1. Passenger Details

Lead name:*

Client name with assistance requirements:*

Booking/Quote reference:*

Departure date:*

Hotel name:*

Destination:*

What is the nature of your disability/assistance requirements? Please give the dates and details of any onset / recurrence of illness, and of any operations you may have had. Please name any medication you are currently taking. If you have mobility difficulties please give details:*

2. General mobility

Can you walk on your own without assistance?*

If so, approx distance?

Will you be accompanied by a professional carer?*

Are you totally confined to a wheelchair/scooter?*

Are you taking your own wheelchair?*

Are you taking your own motorised scooter?*

Is it collapsible?

Is it battery operated?

Carriage of wheelchair/scooter is subject to space availability on aircraft.

If so, is it?

What are the dimensions and weight of your wheelchair/scooter?

Open - Width:

Height:

Depth:

Weight:

Closed - Width:

Height:

Depth:

3. Travel arrangements - by air

Airlines are normally able to provide the following types of assistance. Please indicate which is most suitable for you:

a) Wheelchair to and from aircraft – can climb aircraft steps and make own way to seat.

b) Wheelchair to and from aircraft, assistance with aircraft steps (cannot climb) can make own way on aircraft.

c) Wheelchair required all way to cabin seat – lift onto aircraft, (NB where a lift is not available a full physical carry on will be provided).

    If yes, please provide the weight of the passenger needing the lift onto the aircraft.

d) No airport assistance required – can climb aircraft steps (approx 10-15 steps).

Can you attend to your own needs on the aircraft?

Will you be taking medication during the flight?

If so, please give names of any medication you are taking.
Do you need any stored on the flight?

Are you taking any medical equipment?

If so - what and what size?

Are you asthmatic or do you have other breathing difficulties?

If so, please give details:

Do you have any leg/heart problems? (i.e. amputee, if so which leg/leg needs to be raised/supported/angina/stroke etc)

If so, please give details:

Is it best for you to have an aisle seat?

Do you have any specific seat requests? (Please bear in mind these cannot be guaranteed):
Please note, exit seats will only be allocated to fully able-bodied, adult passengers.


Do you have any further special flight requirements? If so, please give details:

4. Travel arrangements - by sea

Ferry companies are able to provide assistance subject to facilities on board the vessel used. Please check with us for more information if required.

Do you require pre-boarding?

If Yes, please also make this known upon your arrival at the terminal. All vessels have disabled toilets and lifts to and from the car decks. Staff on board will be happy to assist further as necessary, passengers should make themselves known once on board. It should be noted that there is not an ‘extra’ provision of staff for this purpose.


Can you sit in a standard passenger seat on the ferry?

Do you need to remain in a wheelchair/scooter during the crossing?

Can you attend to your own needs on the ferry?

Will you be taking medication during the sailing?

If so, please give names of any medication you are taking.
Do you need any stored on the sailing?

Are you taking any medical equipment?

If so - what and what size?

Are you asthmatic or do you have other breathing difficulties?

If so, please give details:

Do you have any leg/heart problems? (i.e. amputee (state which leg)/leg needs to be raised/supported/angina/stroke etc)

If so, please give details:


Do you have any further special ferry requirements? If so, please give details:

5. Transfer information (where included in your holiday)

Our standard transfers are provided by coach or minibus - Please advise if this is acceptable

If a standard transfer is not suitable:


Do you require a private car transfer?

Do you require a disabled access vehicle?

There may be an additional charge for this.

Remember, you, your party, your luggage and wheelchair will need to be transferred


If a car is required will one vehicle be enough?

If you have not booked transfers with Premier Holidays, and they are not included in your travel itinerary, and you would like to add them to your reservation, please contact us to arrange this for you. If transfers are not included as part of your holiday, we may be able to add these, at the appropriate cost.

6. Accommodation

Can you walk up/down steps?*

Approximately how many?

Do you have a specific requirement regarding room location? If yes,
please give details:
Please bear in mind few hotels offer ground floor rooms – you may wish to request a room near a lift.

Would you like medication to be stored in a fridge?*

If yes, what is it and when will you need access to it?

Does a wheelchair need to go into the bathroom?*

Do you need a bath?*

Or a shower?*

If your preference is not available, will the other be acceptable?*

If you require a shower, is it acceptable if it is over the bath?

Please bear in mind that very few hotels have shower cubicles and even fewer have “walk-in” showers which do not have a lip. Please give details, if this will present a problem for you.

Do you require any special equipment?*

If yes, please give details:
(Charges may be applicable and we cannot guarantee availability).

The majority of hotels do not have specifically adapted facilities for disabled people and you may be required to ‘adapt’ to existing facilities. Some hotels with standard facilities, which, because of their location, or size of rooms, may be more appropriate than others for your needs. In order to assist us in ensuring that the facilities will be suitable, please detail any assistance requirements or information which may help us. (Remember that even bathrooms large enough for wheelchair access may have limited space for manoeuvring).

7. Meals

Do you have a special dietary requirement?*


If yes, please give details for both flights and accommodation:

The completion of this form is not a guarantee that all assistance requirements and requests will be met. This will however enable Premier Holidays to ensure that we have taken all possible precautions to make your holiday as enjoyable as possible. As such, please complete the customer declaration below.

Customer declaration

I confirm that I have detailed any special needs I have on this form and understand that this is the information (and no other) which will be made available to the suppliers. If I wish to amend or add any information at a later stage, I will ensure I do so in writing.

Print name:*

Date:*

Email address:*