Cruise Dialysis

Ambassador Cruise Line Booking Form

Please complete the form below. Once you have done so please click on the submit button at the end. We will then forward your booking information to you.

If you would like to book for more than 2 passengers or have any questions please contact us on 0844 995 1214.

Ambassador Booking Form
Ship *
Cruise *
Have all passengers been fully vaccinated for Covid19, including booster? *
Will either passenger be taking the wheelchair onboard?
Please indicate the type of mobility device you are taking onboard? *
Please be aware that the dialysis unit onboard Ambience and Ambition is not wheelchair accessible. Therefore all patients will need to be able to walk from the door of the unit to the bed.
Will a dialysis patient be occupying this cabin? If yes, please put the dialysis patient's details in the boxes for PASSENGER 1 below *
Is Passenger 1 a dialysis patient? *
Is Passenger 2 a dialysis patient? *
Does the patient currently test negative for Hepatitis B, Hepatitis C, HIV and MRSA? *
Bed Configuration *
Would you like a complimentary upgrade (if one becomes available) - please note some cabins have a bath with a shower over. If you cannot climb into a bath please decline the complimentary upgrade. *
What time would you like to dine in the evening? *
What size of table would you like for your evening meal? *
Do any of the guests have any of the following dietary requirements? *
Do any of the passengers have any sensory impairments? *
Do any of the passengers require supplementary oxygen? *
I have read the email sent to me and understand the cost of the dialysis during my cruise *
I have read the email sent to me and understand the cost of the service charge for my cruise *